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Community Based Rehabilitation

of
Persons with Disabilities
THE DIFFERENT PERSON

The person whom you call blind, is different than you.


He/She can see with the white cane, able to do everything,
if he gets the chance.
The person whom you call lame, is different than you.
He/She can walk with the crutches, able to sing and dance.
The person whom you call deaf or dumb, is different than you.
He/She can work like others, able to hear and talk nicely.
The person whom you call mad, is different than you.
He/She can follow and judge, able to feel the pain and joy.

—Shah Alam Liton


Community Based Rehabilitation
of
Persons with Disabilities

S PRUTHVISH MD DNB (Community Medicine)


Professor of Community Medicine
MS Ramaiah Medical College
Bangalore, India

Formerly
Coordinator
Disability Research and
Training, ActionAid India

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Community Based Rehabilitation of Persons with Disabilities

© 2006, S Pruthvish
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system,
or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and author will not
be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be
settled under Delhi jurisdiction only.
First Edition: 2006
ISBN 81-8061-609-6

Typeset at JPBMP typesetting unit


Printed at Paras Offset Printers
This book is dedicated to persons
with disability and written for
students of physiotherapy and
students of medicine and allied
sciences in the third world to help
to improve the lives of persons
with disability by developing
a perspective towards CBR
and
to my beloved mother who
fought against low vision with
pride and dignity till end.
Acknowledgements
This work is because of the need expressed by the Principals of Physiotherapy colleges
during interactions with them during the period 1999 and 2001. Dr Vasudev, Principal of
Sri Padmashri Institute of Physiotherapy, Dr Vasudev, Principal of Sri Kempegowda Institute
of Physiotherapy Dr Krishna Kumar and Principal of Infant Jesus College of Physiotherapy,
Mrs. Shashikala of JSS College of Physiotherapy expressed need for developing a useful
book on Community Based Rehabilitation for Students of Physiotherapy and Dr Savitha,
Principal of MS Ramaiah College of Physiotherapy. Dr DK Srinivas of RGUHS, Dr C.
Shivaram, Principal, Vaidehi Institute of Medical Sciences and Dr N. Girish, Assistant
Professor of Epidemiology enthused me to accept work of this kind.
The exposure I had in ActionAid India during the period 1992 to 2001 as Coordinator
of Disability Research and Training gave me confidence to take up this task and Dr Krishna
Kumar enthused me take it up and to work it up fast, as well referred my name to the
publishers Jaypee Brothers Medical Publishers. I am grateful to him for the confidence had
on me.
I am grateful to Dr Maya Thomas, Former Director of Disability Division of ActionAid
India who introduced me to the area of Community Based Rehabilitation. Mr T.V.
Sreenivasan, President of Sri Ramana Maharishi Academy for the Blind, Bangalore and
Mr KR Rajendra, Training and Development Officer of eastern region of Leonard Cheshire
International who opened up their field projects for learning, curriculum development for
CBR workers and gave freedom without any kind of barriers, Mr Ravi Narayan, Mr Salil
Shetty, Dr Amitava Mukherjee and Mr Harsh Mander, successive Country Directors of
ActionAid India for the freedom I enjoyed in knowing about CBR, meeting people within
the country and abroad. I am thankful to Mr Mahadevan, Mr Jagabandhu Acharya,
Dr Prashant K Tripathy and successive Directors of Disability Division of ActionAid India
who gave me opportunity to apply my community health knowledge to Community Based
Rehabilitation. Victor Cardoza, Kevin Noronha, Nishitha D’Souza, Susan Thomas Nithila
Bhaskaran, Divya Singh, Raghav, Lalitha and Seetharam, my collegues who adjusted with
me while I was in ActionAid and gave all cooperation to learn about CBR and supported
me to contribute to designing curricula and training programmes for the prestigious
International Training Programme on CBR for Programme Managers and Six month CBR
Worker’s course which is being held in CBR Tharabethi at Sourabha CBR Project of Sri
Ramana Maharishi Academy for the Blind.
I remember with gratitude the support I received from Mr Chapal Khasnabis of Mobility
India presently with WHO, Geneva; Mr R. Ramachandran, Executive Director of ADD India;
Mr DM Naidu of Basic Needs, Mrs. Rukmini Krishnaswamy, Director of Spastic Society
of Karnataka; Dr N. Rathna, Director of All India Institute of Speech and Hearing, Mysore;
X COMMUNITY BASED REHABILITATION OF PERSONS WITH DISABILITIES

Dr G. Gururaj, Professor and Head, Epidemiology, NIMHANS and Dr SP Tekur,


Paediatrician, Bangalore who enhanced my knowledge while designing the training
programmes and conducting training too. Needless to say confidence and independent living
of Ms CN Janaki, Ms Madhu Singhal and Mr Venkatesh made me compile information and
work for this book. Project partners of ActionAid India, CAPART, Government of India,
Govt. of Karrnataka from across the country opened up for me, extended all support for
my learning during my days of ActionAid India.
Nothing is mine in this book. I have collected information from my notes, experiences,
books, journals, evaluation reports from various sources, which has been appropriately
acknowledged in each section. The chapter on “CBR Concepts and Principles” is outcome
of my discussions with and material provided by Mr Ramachandran of ADD India,
Mr KR Rajendra of Leonard Ceshire International, my interactions with various friends
from UNESCAP, WHO, AIFO, ILO, Council for Advancement of People’s Action and Rural
Technology (CAPART), UNDP, many CBR workers and persons with disability of CBR
projects over the years.
The Annexure II on Identification and Needs Assessment of Persons with Disabilities
is largely derived from my experiences during multicentric studies conducted across the
country during the period 1992-93 and from the Monograph “Identification and Needs
Assessment of Beneficiaries in CBR Initiatives“ by Dr Maya Thomas and Dr S. Pruthvish,
published by ActionAid India during 1994.
All my Postgraduates in the Department of Community Medicine have helped me. I
appreciate their help – I specially like to mention Dr Pushpa Naik, Dr Chethan, Dr Shashikala,
Dr Arjun Isaac, Dr Satheesh, Dr Nandakumar, Dr Farah, Dr Jyothi and Dr Riyaz Ahmed.
Dr KN Sharma, our beloved Executive Director of Gokula Education Foundation, Health
Sciences has been nurturing us to initiate CBR through Primary Health Care in Kaiwara
PHC area. I am personally grateful to him.
I am thankful to Dr Mrs. Sandhya Belawadi, Former Principal, MSRMC and Dean,
MSRMTH for expanding my vision to work for HIV/AIDS.
I indebted to Dr S Kumar, Principal, MSRMC and Dean, MS Ramaiah Medical College
and Hospital and Mr BR Prabhakara IAS (Retd) and CEO of Gokula Education Foundation,
Bangalore.
This book is seeing the light of the day when one of my ambitions is being fulfilled—
initiation of a CBR endeavor. Dr Madan Upadhyaya, former Regional Adviser—Injury
Prevention, Disability and Rehabilitation, SEARO, WHO and Dr S Ramboot, former Regional
Advisor, non-communicable Diseases and Mental Health, WHO, SEARO has been providing
technical and financial support to this endeavor.
I fall short of words to thank Dr K. Jayanth Kumar, Professor and Head, Community
Medicine for sharing my vision towards developing a CBR endeavor in Kaiwara PHC area,
and permitting me to avail leave to complete this work. I am immensely thankful to
Dr D. Gopinath, Professor of Community Medicine for being with me for its implementation
ACKNOWLEDGEMENTS XI

and to enlarge my vision to include Chronic Care, I am grateful to MSRMC for giving me
opportunity to place the agenda of CBR in the field practice area of MS Ramaiah Medical
College, Bangalore. I am especially indebted to Dr T. Hemanth, Dr Ravish, Dr M. Dayanand,
Dr Mrs. Renuka Prithviraj who stood with me and continuing to do so. Experience at
Kaiwara augured my enthusiasm to devote time and energy to pool my experiences.
Mr NSN Murthy, Associate Professor, Statistics, Department of Community Medicine,
MSRMC has been of lot of support to initiate the CBR endeavor in Kaiwara PHC area.
I am grateful to my wife Jyothi, children Sindhu and Sachin, and my mother for tolerating
my non-availability to them adequately during the preparation of this work. Jyothi helped
me write/edit suggest changes throughout. It was a great support for me for the book
to reach this stage. It would have not been possible to contemplate without her patience,
respect and love for me.
I am thankful to Ms. Soumya Gaurav, student of Physiotherapy in MS Ramaiah Medical
College who carried the message of CBR to students of Physiotherapy in Kempegowda
Institute of Physiotherapy and who is remotely responsible for making me work on this
book. She responded to my calls to learn about CBR while she was an undergraduate
student.
I immensely thank the Chairman and Managing Director of Jaypee Brothers Medical
Publishers, Shri JP Vij for making this book available to students of Physiotherapy. I am
confident that this will help the students to develop a perspective towards CBR approach
in their work and will enable them to develop compassion and will make lives of persons
with disability easier.
I am thankful to Anil, Theju, Vanditha and team for the preparation of drafts.
Preface
Community Based Rehabilitation (CBR) for, of and by persons with disabilities is proposed
by world bodies like World Health Organization as a cost-effective approach towards
rehabilitation. The joint statement of WHO, ILO, UNESCO clearly delineates concepts and
principles of CBR.
Physiotherapists constitute a major human resource, which is yet to be tapped for CBR
optimally. There is need to bring in the approach of CBR in every facet of their work. Then
only it will be possible to reach 2.13 percent of the population of India who are disabled,
about 74 percent of them living mostly in villages and slums, according to Census of India
2001. It is a good step that Health Universities in India have a subject in CBR for students
of Physiotherapy. While it will be possible to introduce CBR through this way, more will
be gained if attempts are made by Physiotherapy Colleges and teachers of Physiotherapy
to develop demonstration projects in the proximity of their institutions. This will help making
learning of CBR easier, more meaningful and useful to students. Indeed, I feel that teaching
of CBR should be reflected in all aspects dealt with in the entire curriculum of Physiotherapy
course. CBR provides an opportunity for institutions and teachers of Physiotherapy to
be role models and express their social accountability in teaching, research and service
and empowerment areas of their work.
The book is designed to meet the requirements of undergraduate students of
Physiotherapy of Indian Universities and I understand it is a maiden attempt in the
developing world. I request the faculty and students to help me with their critical comments
and suggestions to improve this first edition.
Meeting the syllabus of Indian Universities for undergraduate students in CBR, it
addresses to cover areas of History of Rehabilitation, Disability – definition and
classification, Disability Identification, Disability Prevention, Early Identification and Early
Intervention, Concepts, Principles and Components of Community Based Rehabilitation,
Planning and Implementation of CBR, Supervision, Monitoring and Evaluation of CBR,
Resources for CBR and Disability Rehabilitation, Legislations, Aspects of Vocational Training
and Employment, Role of Physiotherapists in CBR. Assignments and practical learning
exercises in CBR are also suggested.
With useful case studies and illustrations, it is hoped that the book will sensitize the
students and faculty of Physiotherapy to adopt CBR approach in their work.
The book will be useful for students of Medicine and Nursing to gain more knowledge
about Community Based Rehabilitation. Many of my friends feel its usefulness for NGO
sector too – for implementation.
VIII COMMUNITY BASED REHABILITATION OF PERSONS WITH DISABILITIES

I am grateful to Sri BR Prabhakara, Chief Executive GEF- Health Sciences, Dr KN Sharma,


Executive Director, GEF- Health Sciences, Dr Mrs MR Sandhya Belawadi, former Principal
and Dean, MSRMC and MSRMTH, Dr S Kumar, Principal, MSRMC and Dean MS Ramaiah
group of Hospitals, Dr AC Ashok, Registrar, MS Ramaiah Medical College for the
encouragement and support.
The book has seen the light of the day because of the support I received from
Dr K Jayanth Kumar, Professor and Head, Dept.of Community Medicine, Dr D Gopinath,
Professor of Community Medicine, Mr NSN Murthy, Associate Professor (Medical Statistics)
my colleagues – Dr Renuka, Dr M Dayanand, Dr NSR Gowda, Dr Ravish, Dr Hemanth
T, Dr G Suman, Dr Lalitha, Mr. Shivaraj, Mrs.Bhuvaneswari and all PG Students – Dr
Pushpa Naik, Dr Satheesh, Dr Chethan, Dr Farah, Dr Arjun, Dr Jyothi, Dr Shashikala, Dr
Riyaz, Dr Raguhurm, Dr Sudeep Dr Sridevi and Dr Nandakumar.
A large number of people, friends, and experts have helped me do this work – by
suggestions and criticisms. I have tried to list in the acknowledgement. I am grateful to
ActionAid India for the opportunity to have the experience of CBR and Dept. of Community
Medicine, MS Ramaiah Medical College and Gokula Education foundation for giving me
adequate leave to work for this book as well continue my commitment and interest in CBR
I am indebted to Shri Jitendar P Vij, Chairman and Managing Director, Mr.Tarun Duneja,
General Manager, Publishing of M/s Jaypee Brothers Medical Publishers (P) Ltd. and
Mr Manjunath Hegde, Author-Coordinator, Bangalore Branch and the entire team for the
opportunity to me to reach students of Physiotherapy which was my long cherished
ambition, as well as highly professional work they have put in.
I fall short of words to thank my wife Jyothi, daughter Sindhu, son Sachin, my beloved
mother for helping me complete the task and for having tolerated my non-availability to
them now and then.

Banda Ache S Pruthvish


Indonesia
Contents
1. History of Rehabilitation of Persons with Disability ................................................... 1
2. Disability: Definition and Classification .......................................................................... 6
3. Prevention of Disabilities .................................................................................................... 14
4. Disability Identification ....................................................................................................... 22
5. Early Identification and Early Intervention for Disabilities ..................................... 36
6. Concept, Principles, Components of Community-based Rehabilitation ................ 41
7. Planning and Implementation of Community-based Rehabilitation ...................... 58
8. Supervision, Monitoring and Evaluation of Community-based
Rehabilitation .......................................................................................................................... 74
9. Resources for CBR and Disability Rehabilitation ........................................................ 89
10. Legislations ............................................................................................................................. 117
11. Vocational Training and Employment of Persons with Disability ....................... 126
12. Role of Physiotherapists in Community-based Rehabilitation of
Persons with Disabilities ................................................................................................... 133
Annexures .................................................................................................................................. 137
Index .......................................................................................................................................... 221
History of
Rehabilitation of
1 Persons with Disability
LEARNING OBJECTIVES
At the end of the learning session, the learners must be able to appreciate and list milestones
in the history of rehabilitation of disabled in the country.

OUTLINE OF THE CONTENT


• Epics/Legends
• Ridicule
• Charity and government support
• Effects/developments during World War II
• Independent living movement
• Institution-based rehabilitation
• Community-based rehabilitation
• Prejudice to dignity

SUGGESTED METHODOLOGY
• Lecture/discussion: Arranging oration by eminent people who have worked for disability
issues.
• Watching the films: My Left Foot/Koshish/Heidi/Beautiful Mind.

PRE/POST EVALUATION
• List disabled people from Epics/History
• How disabled people’s needs were addressed in the past?
• List important milestones of development.

HISTORY OF REHABILITATION
In Mahabharath, renowned emperor of Hasthinapura, Dhritharashtra was blind. Shakuni
was lame. In Hindu purana—Aruna, the Sarathi (driver) of Sun God was deprived of both
his limbs, but was the fastest driver of the chariot of Sun God.
2 Community Based Rehabilitation of Persons with Disabilities

In ancient times hardly any one helped the handicapped. The welfare of the group
depended on the ability of each member to fight and to work. Handicapped people who
could not fulfill their responsibilities threatened the safety of all and many were driven
away and left to die. Most ancient people believed that evil spirits caused injury or disease,
the spratans let deformed children die of exposure. In Rome, its parents could legally drown
a disfigured infant.
During the middle ages, from about the AD 400 to the late 1400 people ridiculed the
handicapped and regarded them with suspicion. Some nobles used Physically Handicapped
as Jesters. Many handicapped people were burned as witches. Attitude towards handicapped
began to change during 1800s. Many people began to pity the disabled and treated them
with special care. Nevertheless individuals with handicaps were brought to bring shame
on themselves and their families. As a result most handicapped people were kept hidden
away at home or in special institutions.

SOME MISCONCEPTIONS ABOUT PEOPLE WITH DISABILITIES


People with disabilities are ill: The general health of people with disability is as good as anyone else’s.
People with disabilities are also intellectually disabled: This is true only for those with intellectual
disabilities, e.g. mental retardation.
People with disabilities are lazy: People with disabilities are no lazier than anyone else. Not only must
disabled people work harder, they in fact do work harder.
Nature compensates people who are disabled with special abilities: People with disabilities are not
automatically compensated with better abilities in other functions.

Source: Foo Galk Sim (1999)


“Integrating women and girls with disabilities into main
stream vocational training – a practical guide ILO, Bangkok.
ILO East Asia Multidisciplinery Advisory Team
ILO Regional Office for Asia and the Pacific

Impact of World War II


During the mid-1900s important advances were made in the treatment of handicapped. Until
that time, many people who became paralysed below the waist died as a result of urinary
problems. But, in the 1940s the discovery of certain antibiotics enabled doctors to help such
victims lead full, productive lives. During and after the World War II (war ended in 1945)
extensive efforts were made to rehabilitate disabled servicemen. Military hospitals
established rehabilitation centers and soon many other hospitals also set up these facilities.
Many countries now make some provision for the education and employment of the
handicapped people.

Motivation, Training and Achievement of Disabled Persons


With proper motivation and special training, even the most severely handicapped people can
lead productive, fulfilling lives. Most famous people have overcome handicaps to make
important contributions to mankind. The English poet John Milton was blind when he wrote
History of Rehabilitation of Persons with Disability 3

his epic masterpiece “Paradise Lost”. The great German composer Beethoven wrote much of
his finest music after he became deaf. Franklin D Roosevelt, paralyzed in both legs by Polio
at the age of 39 years, became President of United States. The American Helen Keller became
blind, deaf and mute before she was two-year-old, but she learnt to read, write and speak.
She devoted her life to helping the deaf and the blind. Christ Brown, an Irish author and poet,
was born with cerebral palsy. He taught himself to write with his left foot. His autobiography
‘My Left Foot’ was published in 1954 and has been made into a film.
Thaimur Khan, who was lame, was a great warrior who conquered most of the world.
Louis Braille developed communication for blind through Braille script.
Panchakshari Gavai, hindustani vocalist, ran a boarding school to teach music to poor
and blind children. Puttaraja Gavai—his disciple following the suit. Mrs. D. Suryaprabha
is a famous violinist in Bangalore. The young Maruthi Prasad of Sri Ramana Maharishi
Academy for the blind sings very well and surprises everyone.
CN Janaki, whose both limbs are paralysed due to poliomyelitis in childhood, learnt
swimming after she was thirty and swam the English Channel. Many blind students of Sri
Ramana Maharshi Academy for Blind have learnt Bharath Natyam with enthusiasm and
determination and have performed the world over.
Stephen Hawking, the Noble laureate who is stuck to wheelchair, has made difference
in the area of Physics.
Sudha Chandran, who lost her limb in an accident dances with artificial limb and is a
famous actress too.

MEETING PEOPLE WITH DISABILITIES


In general, greet a disabled person and behave just as you would with anyone else in your culture
and country.
When meeting someone in a wheelchair:
• Put yourself at their level.
• If you are behind a high desk/counter, more to the front.
• Offer help with heavy doors.
When meeting someone with a hearing impairment:
• Always face the person. If the person lip-reads, speak clearly and slowly.
• Speak directly to the person, if there is a sign language interpreter.
• With those who have speech difficulties, if possible ask questions that require short answers—
a yes or no.
When meeting some with a visual impairment:
• Always identity yourself first.
• If you are moving away, tell the person. Do not leave her talking to an empty space.
• If she needs to be guided to a place, offer your arm so that you will be walking slightly ahead of
her but beside her.
Source : Foo Galk Sim (1999)
“Integrating women and girls with disabilities into main stream
vocational training – a practical guide ILO, Bangkok.
ILO East Asia Multidisciplinery Advisory Team
ILO Regional Office for Asia and the Pacific
4 Community Based Rehabilitation of Persons with Disabilities

Independent Living Movement


Developing countries like India have the problem of population, communicable diseases,
lack of education, less purchasing power. These make rehabilitation a challenging process.
In developed countries we see Independent living movement as a concept and approach
for rehabilitation.
It is cost-intensive. India has a population of more than 100 crore living across 6.65
villages, 3000 towns and cities. It is out of reach to look at Institutional-based
rehabilitation—Special schools for the hearing impaired, visually disabled, those with mental
retardation, cerebral palsy and multiply disabled; special residential settings for severely
disabled. Situation is same in all developing countries. However, NGO movement in the
country has tried to address this through establishment of special schools. We see more
than 3000 NGOs working in this direction. Government has also established many special
schools and developed schemes for the welfare of the disabled. It is estimated that these
existing attempts reach only 3 to 5 per cent of disabled population, which is more than
50 million in the country. How to address the needs of the rest?

Special education: Is instruction designed to help persons/children with disabilities use their full
learning ability. It includes instruction in class room, at home and in hospitals and specialized institutions.
Teaching disabled children requires special skills and materials. A specially trained teacher may be
needed to teach children with mental retardation to care for themselves and to teach them basic school
syllabus.
The World Book Encyclopaedia (International) 1992.

Vocational Training: Partially sighted children may require books with large print. Blind children learn
through braille books and talking books (recordings on records/tapes). Computer aided voice synthesisers
have made difference to person with visual disabilities.
Vocational training prepares persons with disabilities to hold a job.
The World Book Encyclopaedia (International) 1992.

Community-based Rehabilitation
In 1979, at Alma Ata, Russia—when primary health care was mooted by WHO, community-
based rehabilitation was proposed as an attempt/approach for rehabilitation. In community-
based rehabilitation, focus is on rehabilitation process as part of development process, with
focus on skill transfer from professionals to families, disabled persons and community
volunteers; appropriate technology using the locally available resources. We see attempts
in this direction in India by many agencies like ActionAid India, Christoffel Blinden Mission,
District Rehabilitation Scheme of government of India and umpteen number of small-scale
efforts by many NGOs in the country. Grameena Punarvasa Yojana and National Programme
for the Rehabilitation of Persons with Disabilities (NPRPD) are attempts by government
of India towards community-based rehabilitation since last 3 years.
Rehabilitation Medicine
Is a branch of medicine that helps improve the condition of disabled people. In most cases, rehabilitation
is carried out by a hospital by a team of specialists headed by a physician. The specialist may include
nurses, psychologists, social workers, speech therapists and various others.
Contd...
History of Rehabilitation of Persons with Disability 5

Contd...

Many people with disability are helped by physiotherapy which involves treatment by heat / light / water.
It may include special exercises that restore patient’s endurance and muscle strength.
The World Book Encyclopaedia (International) 1992.

Occupational Therapy
Helps overcome / reduce handicaps by teaching patients various skills. E.g. A person who has lost
both legs may learn how to drive a specially equipped car.
The World Book Encyclopaedia (International) 1992.

Prejudice to Dignity
Another important milestone in the history of rehabilitation is growing realization for
empowerment of people with disabilities, protection of their rights, equal access and
opportunities and their integration into the mainstream as important attempts towards
rehabilitation. Towards this end we see the formulation of UN Standard Rules by United
Nations, enactment of disability legislations across the globe and India being a signatory—
we see the enactment of Disability Act of 1995 in our country. Empowerment approach,
organization of disabled people and working for community-based rehabilitation through
organized groups of disabled people, community-based groups, parent’s groups is being
attempted. Efforts of action on disability and development, an organization based in UK
with operations in India and many developing countries, e.g. Pakistan, Afghanistan,
Bangladesh is laudable.

Disability and Development


With the growing realization that rehabilitation is part of any development effort, we see
many development agencies attempting to address/incorporate disability components in
development programmes. ActionAid India, Oxfam, DFID (formerly, ODA), central and
state government programmes.

The symbol of ‘Wheelchair’: Is often need to indicate area reserved for persons with disability. It may
be toilet, it may be car parking, it may be a seat in a bus/train. It may be vehicle being driven by a
person with disability.

ASSIGNMENT FOR STUDENTS


1. Collect biographical sketch of Milton/Louis Braille/Helen Keller/Beethoven/Roosevelt/
Christ Brown/Panchakshari Gavai/CN Janaki/Javed Abidi/Sudha Chandran; prepare
charts for display.
2. Access and browse the website: www.unescap.org

BIBLIOGRAPHY
1. Bharatheeya Vidyabhavan “Mahabharath”, Bharatheeya Vidyabhavan.
2. Einar Helander “Prejudice and Dignity” UNDP.
3. Peter Coleridge “Disability, Liberation and Development” OXFAM.
4. R S Pandey, Bhushan Punani (1993) “Perspectives in Disability and Rehabilitation” Disability Division, Action-
Aid India, Bangalore, India.
Disability: Definition
2 and Classification
LEARNING OBJECTIVES
At the end of the session, the participants should be able to:
1. Explain differences between impairment, disability and handicap.
2. Understand and appreciate magnitude of problem of disability in the country.
3. List major causes of disabilities. List major types of disabilities.
4. Appreciate the need for integration of disabled people into the main stream of the society
as well integration of services for disabled people.

OUTLINE OF CONTENT
• Definitions and explanation of impairment, disability and handicap.
• Magnitude of the problem of disability—evidence base from different sources.
• Causes of disabilities
• Types/classification of disabilities.
• Excerpts from the book Disability, Liberation and Development by Peter Coleridge.

SUGGESTED METHODOLOGY
Lecture—Discussion

PRE/POST EVALUATION
• How many people with disability may be found in a village of 1000 population?
• What are common types of disabilities?
• What are major causes for disabilities?

IMPAIRMENT, DISABILITY AND HANDICAP


Definition
Impairment is any loss or abnormality of psychological, physiological or anatomical structure
and function, e.g. loss of foot, defective vision or mental retardation.
Because of impairment, the affected person may be unable to carry out certain activities
considered as normal for his age, sex, etc. A disability is any restriction or lack (resulting
Disability: Definition and Classification 7

from impairment) of ability to perform an activity in the manner or within the range
considered normal for a human being.
Because of disability, the person experiences certain disadvantages in day to day living;
is unable to fulfill the obligations required of him and play the role expected of him in
society. A handicap is a disadvantage for a given individual, resulting in an impairment
or disability that limits or prevents the fulfillment of a role that is normal (depending on
age, sex, social and cultural factors) for that individual.
Taking accidents as an example, the above terms can be explained further as follows:
Accident .................................................. disease or disorder
Loss of foot ........................................... impairment
Cannot walk .......................................... disability
Unemployed .......................................... handicap.

Magnitude of Problem of Disability


Present policies and programmes suffer from a dearth of disability data and inadequacy
of existing data. In the majority of countries of Asia Pacific region, it is difficult to ascertain
the prevalence of disability. There is wide variation in estimated disability rates reported
by the developing and developed countries. The variation of course depends to a large
extent on definition of disability used, which either expands or limit the disability groups
covered in the survey. For example, Australia’s 1993 survey reported that persons with
disability comprise 18 percent of the population and New Zealand’s first National household
survey (1996) yielded a disability rate of 19.1 percent. In contrast, China’s (1987) and
Pakistan’s (1984-85) sample surveys both indicate 4.9 percent disability rate.
India’s disability rate from 1981 sample survey is 1.8 percent. The 1991 sample survey
of India covering four disabilities (Locomotor, visual, hearing, speech) yielded a prevalence
rate of 1.9 percent. A separate national sample survey of persons with delayed mental
development in India yielded an estimate of 3 percent of population aged 0 to 14. Variations
in survey outcomes highlight a common problem.
The operational definitions used pertain to the purpose for which data are collected,
that is, the answer depends on why the question is posed. Since common definitions and
classifications of disability are not uniformly applied by countries, international comparisons
of disability data are not meaningful. This calls for greater inter-country effort to adopt
internationally agreed concepts, definitions, scope and classifications, possibly including
survey methodologies, techniques and survey questionnaires.
Childhood disabilities are more common in developing countries and disabilities due
to advanced age are common in developed countries. We observe a decreasing trend in
prevalence of lameness due to poliomyelitis in India, which is heading for elimination of
polio.
WHO estimates that 5 percent of population in developing countries is an acceptable
figure. According to this, we may extrapolate to say—there are 50 million persons with
disability in our country.
8 Community Based Rehabilitation of Persons with Disabilities

Table 2.1: World population, as projected (medium-variant) by United Nations, 1990-2015

POPULATION IN MILLIONS

Year In more developed regions In less developed regions Total

1990 1,207 4,086 5,293


1995 1,236 4,534 5,770
2000 1,264 4,997 6,261
2005 1,289 5,451 6,740
2010 1,310 5,865 7,205
2015 1,327 6,332 7,659
2020 1,342 6,750 8,092
2025 1,354 7,150 8,504

Table 2.2: Population in less developed regions. Projection by age groups

Age Group POPULATION IN MILLIONS Growth

1990 2025

0-4 0,544 0,620 + 14%


5-14 0,909 1,225 + 35%
15-29 1,178 1,782 + 51%
30-64 1,273 2,955 + 132%
65+ 182 568 + 212%
Total 4,086 7,150 + 75%

Source: Einar Helander “Prejudice and Dignity“ UNDP

Table 2.3: Global estimate of prevalence of moderately and severely disabled people, based on the UN
population projections for 1990, and on assumptions about disability made by Dr.Einar Helander, UNDP.

More developed regions Less developed regions Total

Total Populations (millions) 1,207 4,086 5,293


Prevalence of moderate and severe disability 7.73% 4.47% 5.21%
Number of moderately and severely disabled people (millions) 93.3 182.2 276.1

Source: Einar Helander “Prejudice and Dignity“ UNDP

Causes of Disability
Macro-economic Conditions
The prevalence and patterns of disabilities are affected by state of health of individuals,
and by the social (family and community) and physical environments, which sustain them.
Personal, family and environmental health is in turn strongly influenced by economic trends
including trends in the prevalence of poverty and inequity. Inequitable economic and social
policies are contributing to prevalence and patterns of disabilities today and will do in
foreseeable future.
To maximize profits, production is often located wherever costs are lowest, regulations
lax and workers least likely to organize for better working conditions and fairer wages.
This can result in high rates of accidents, poisoning from toxins, loss of hearing and vision
and health deterioration.
Disability: Definition and Classification 9

Nutritional Deficiency
In theory, world produces more food for everyone, yet, problems remain concerning
equitable distribution to those in need of food. Common micronutrient deficiencies that
will continue to affect disability include:
• Vitamin A deficiency: blindness
• Vitamin B complex deficiency: Beriberi, Pellagra, Anemia
• Vitamin D deficiency: Rickets
• Iodine deficiency: slow growth, learning difficulties, intellectual disabilities, goiter
• Iron deficiency: which impedes learning and activity and is cause of maternal mortality also
• Calcium deficiency: osteoporosis.

Weapons and Violence


The large-scale production, sale and deployment of landmines have been significant cause
of disability in recent years, e.g. Afghanistan and Cambodia.
Civilians—mostly children and women in poverty constitute majority of victims and not
combat soldiers. Violence in all forms has increased dramatically and men between 15 to
35 constitute to be victims. The increased availability of all types of guns has altered the
consequences of conflict and crime.

Chemical Substances
Substances—drugs like thalidomide, glutethemide in the past have contributed for children
born with birth defects.
Pesticides, oil fires and decontaminating agents (reproductive dysfunction), insect
repellents, anti-nerve gas pills, vaccination for anthrax and botulism, instances of terrorism
where nerve gas is used constitute chemical substances as a cause.

Other Causes of Disability


Rapid modernization: Depression, alcoholism and schizophrenia; heart disease, cancer, mental
disorders. Smoking, environmental pollution—air pollution - is important causes for chronic
obstructive lung disease. Noise pollution and smoking are causes for Hearing impairment.
Road Industrical accidents: Amputated limbs, quadriplegia, paraplegia, brain damage and
behavioral disorders are among the disabilities following road traffic accidents.
Population aging: With the aging of populations, disabilities associated with increased
longevity will increase. In some societies of Asia Pacific region, persons born with disability
are likely to survive far longer than disabled persons born in the first half of the present
century. Aging related disabilities include: Blindness, hearing impairment, musculoskeletal
diseases and mental disorders. Most chronic, degenerative, non-communicable diseases or
diseases of second half of human life, Alzheimer’s disease.
Infectious diseases: Poliomyelitis, trachoma, leprosy, tuberculosis, measles, whooping cough,
streptococcal infections, smallpox (in the past). German measles and other viral infections
among pregnant mothers may cause birth defects.
10 Community Based Rehabilitation of Persons with Disabilities

Infection of certain organs: Conjunctivitis, ear infections, osteomyelitis, improper wound


treatment is causes for disabilities too.
Other causes: Consanguineous marriages, exposure to X-rays and harmful drugs during
pregnancy.

Specific Causes for Certain Disabilities


Visual disabilities: Cataract, trachoma, glaucoma, small pox, vitamin A deficiency, injuries
and accidents.
Communication disabilities (speech and hearing): Infections of ear, nose and throat; injuries and
accidents; use of drugs which can affect hearing like aspirin, streptomycin, etc; infections
like rubella in the mother during pregnancy; senility; use of harmful drugs during pregnancy;
exposure to excessive noise in industries; psychological causes—neglect of child by parents,
child abuse, etc.
Mental retardation: Before birth: Malnutrition, genetic abnormalities, infectious diseases, intake
of drugs, alcohol, accidents
During birth: Prematurity, injury during delivery, prolonged labour, others.
After birth: Malnutrition, infections, asphyxia, lack of stimulation, poisoning, child abuse.
accidents affecting brain.
Locomotor disabilities: Poliomyelitis, accidents/injuries, stroke, amputation, leprosy, cerebral
palsy, exposure to drugs, X-rays, infections during pregnancy.
Cerebral palsy: Before birth: Influenza, rubella, mumps affecting pregnant mother during first
three months of pregnancy, exposure to drugs, poisonous substances, radioactive materials,
X-rays during pregnancy, poor nutrition, Rh incompatibility of parents.
During birth: Difficult and prolonged labour, trauma, lack of training in use of instruments
during delivery, improper use of anesthesia, anoxia, internal bleeding.
After birth: Head injuries, very high fever with convulsions, and complications of infectious
diseases like malaria, leprosy, poliomyelitis, meningitis, and encephalitis.
Epilepsy: In many cases cause may not be known. Space occupying lesions like tumours in
brain, abnormal conditions of the brain like infections, blood clots, tumours, head injury,
etc.
Mental Illness: Heredity, social/psychological causes like worry, anxieties, emotional stress,
tension, frustration, unhappy marriages, broken homes, stresses of poverty, industrialization
and urbanization, changing family structure, population mobility, insecurity, cruelty,
rejection.
Certain infections, toxic chemicals, drugs. Organic conditions like aging of arteries of
brain, chronic diseases like tuberculosis, leprosy epilepsy, etc.
Disability: Definition and Classification 11

Table 2.4: Causes of disability and estimated prevalence of moderately and severely disabled people
in the world, estimates for 1990

Causes of disability Global suggested ranges of estimates of the prevalence of moderately


and severely disabled people (world population 5,300 million) millions

Congenital or perinatal disturbances


Mental retardation 10-20
Somatic hereditary defects 10-25
Non-genetic disorders 15-20
Communicable diseases
Poliomyelitis 5-10
Trachoma 8-10
Leprosy 3-4
Other communicable diseases 30-40
Non-communicable diseases 70-80
Functional psychiatric disturbances 15-20
Alcoholism and drug abuse 20-30
Trauma/Injury
Traffic accidents 15-20
Occupational accidents 10-12
Home accidents 15-20
Other 2-3
Malnutrition 7-10
Other 2-3
Estimated Total 250-300

Source: Einar Helander “Prejudice and Dignity“ UNDP

TYPES/CLASSIFICATION OF DISABILITIES
There are six major types of disabilities. They are:
• Locomotor disabilities
• Visual disabilities
• Communication disabilities
• Mental retardation
• Cerebral palsy
• Mental illness
• Multiple disabilities (more than one disability in the same person).
Autism, learning disabilities, etc emphysema, cancer, heart disease, multiple sclerosis,
etc. are other types of disabilities.
Disabilities may be classified as mild, moderate, severe and profound. Categorization
of disabilities is a difficult task. Government of India has suggested certain norms. Disability
Act of 1995 also specifies certain norms for classification based on severity to help
certification for receipt of certain benefits under different schemes. Some of these which
are especially useful for categorizing persons with visual and hearing disabilities and mental
retardation are given in Tables (Annexure III).
12 Community Based Rehabilitation of Persons with Disabilities

NEED FOR INTEGRATION


Disability is an issue that touches all. It is not only or even mainly associated with poverty:
disability can affect anybody of any background, in any country at any time.
Development is ultimately about people having control over their own lives. Charity
is about people remaining as victims, controlled by others. Programmes and projects in
disability especially in developing countries are still in the main designed exclusively by
able bodied people and tend to leave disabled people out of the decision-making process.
In many developing countries disability is often perceived by aid agencies as a problem,
but not as a priority.
Most disabled people in developing countries, if they have been exposed to any services
at all, have experienced only a medical or institutional model of rehabilitation, which treats
them as passive recipients.
Whether institution-based or community-based or whatever—disabled people are human
beings with all the economic, emotional, physical, intellectual, spiritual, social, and political
needs that other people have. The main implication in this is that unless they are involved
in planning and implementation of services, these services will always be inadequate in
extent and in philosophy, whatever form they take. A disability programme, no matter
how community based is not developmental unless disabled people play a leading part in
its design and implementation.
Is it possible to accept impairment? Many disabled people say they never accept it, in
the sense required by an able-bodied and non-understanding world. They resent being
told they have to come to terms with their condition, rather it is the able-bodied world
that has to accept or to come to terms with disability. What disabled people have ‘to cope
with’?
Is not their impairment, but the hostility, prejudice and discrimination that they meet
every day of their lives, for no other reason than that they are disabled?
There is a need to set up rehabilitation services involving disabled people as decision-
makers in the programme. Such an attempt should aim making disabled people integrated
into the mainstream of the society. This is possible only if equal access and equal
opportunities exist for both disabled and non-disabled people. This is towards integration
of disabled people.
There is a need to integrate various service components of different departments—
education, health, welfare, employment and labour to achieve the best out of the existing
resources. This is towards integration of existing services for disabled people.
Both type of integrations are necessary. Former makes life easier for people; latter makes
existing services user-friendly and cost-effective and larger reach.

ASSIGNMENT FOR STUDENTS


Observe disabled people in their neighbourhood of residence and find out their
needs.
Disability: Definition and Classification 13

Table 2.5: Most common felt needs concerning disabled people in the developing countries

Functions problems in daily life activities


• Self-care (eating, drinking, dressing, keeping clean by use of latrine or by “going to nature”)
• Mobility
• Communicating, comprehension, ability to follow instructions behaviour.
Educational needs
• Schooling
• Vocational training
Needs for income-generating activities
• Participation in household duties, jobs, self-employment
Lack of family and social integration
Concerns relating to participation and representation in community affairs
Security needs (protection of legal and human rights)

Source: Einar Helander “Prejudice and dignity” UNDP

BIBLIOGRAPHY
1. Maya Thomas, Pruthvish S. “Identification and needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives “Monograph Published by ActionAid India (1993).
2. Park K. “Text Book of Preventive and Social Medicine”, Banarasi Das Banot (Publishers) Calcutta, 17th Edition
3. UNESCAP, Bangkok “Prospects for persons with disabilities” in “Millennium Supplement on Disability” Action-
Aid Disability News, pp. 70-93, ActionAid Disability News, Vol 11, Issue 1 and 2, 2000
4. UNICEF Nepal—Kit on Disability
Prevention of
3 Disabilities
LEARNING OBJECTIVES
1. The learners should be able to appreciate and explain primordial, primary, secondary
and tertiary levels of prevention measures in disease states/disability prevention.
2. The learners should be able to list prevention programmes under different levels of
prevention.

OUTLINE OF THE CONTENT


• Efforts of UNICEF and WHO in this direction.
• Primary prevention.
• Secondary prevention.
• Tertiary prevention.
• Primordial prevention.
• Implementation of prevention programmes at community level.
• Need for transfer of skills to grassroots level workers and family members—for early
identification and early intervention.
• Brain growth and physical growth of the body.

SUGGESTED METHODOLOGY
• Lecture—discussion using Audio-visual aids.
• Participation in immunisation programme of PHC/Urban Family Welfare Centre;
nutrition demonstration in an Anganwadi, antenatal and postnatal clinics in PHC/Urban
Family Welfare Centre.

PRE/POST EVALUATION
• What is Prevention?
• List preventive measures to reduce the burden of disability.
Prevention of Disabilities 15

• What is the role of Physiotherapist in Prevention, Early Identification and Early


Intervention for Disabilities?

Efforts of UNICEF and WHO


The whole world is appreciating and experiencing the efforts of UNICEF, WHO and other
organizations now, with respect to prevention of disabilities. We see three important
experiences during the present century which have made obvious to us prevention of
disabilities needs to be an important and indispensable component of any health/community
based rehabilitation programme.

UNICEF–United Nations Children’s Fund


Activities of UNICEF focus Child Survival, protection and development. Interventions like Immunization,
improved infant feeding practices, child growth monitoring, home-based diarrhea management, drinking
water, environmental sanitation, birth spacing, education of girls, income-generating activities for women.
As full partners in Primary Health Care, UNICEF and WHO have been developing joint strategies in
support of its implementation at country level.

Landmine victims in Vietnam and Cambodia, Earthquake in Gujarat, Cyclone in Jagathsinghpur is


examples of situations where rehabilitation services are needed. Handicap International has contributed
in a big way in Cambodia and Vietnam.

Efforts of Government of India


The Universal Immunisation Programme of Government of India augured with reproductive
and child health components has made remarkable changes—we do not see many children
with polio lameness—like we use to come across before 1984. There is a definite reduction
and India is reaching the stage of polio eradication.
In 1982-83, when Honorable Prime Minister of India Late Smt. Indira Gandhi launched
Leprosy Eradication Programme, people were wondering whether the effort would be a
myth or reality. Today, after the successful phases of early identification and treatment
with multidrug regimen—we notice remarkable reduction in the incidence and prevalence
of disease and disabilities due to leprosy.
While polio eradication is due to specific protection of the population by effective vaccine,
reduction in leprosy is because early diagnosis and treatment by effective drugs. Another
remarkable success story of the century is eradication of small pox and prevention of blindness
due to small pox.
In rehabilitation programmes, apart from early identification and early intervention
(secondary prevention) there is need to advocate, promote and implement primary
prevention measures. The old adage “prevention is better than cure” and “stitch in time
saves nine” is valid at all times.
16 Community Based Rehabilitation of Persons with Disabilities

Three Big Successes of Public Health Programmes


(Smallpox, Poliomyelitis and Leprosy)

Impact of Immunization Programmes


Smallpox eradication: Smallpox vaccination helped in a big way to prevent blindness due to smallpox.
Smallpox is no more a cause of blindness in India.
Control of poliomyelitis: Today, if we visit villages and slums, we find people with post polio residual
paralysis in the age group above 15 years and very less number below 15 years. Needless to say
this is the impact of Universal Immunization programme initiated from 1984 in a phased manner
throughout the country in 600 Districts of India. WHO, UNICEF and International Rotary have contributed
in a big way for this success, especially – prevention of Poliomyelitis.
Impact of chemotherapy in leprosy: It is nice to note that today – we see many organizations working
for Leprosy have less work to do with respect to leprosy and are branching out to do Community Based
Rehabilitation work for all kinds of disabilities. Credit for this goes for large number of dedicated workers
and organizations in Voluntary as well as Government sector starting from Mahatma Gandhi and multidrug
treatment initiated with National Leprosy Eradication Programme.

Immunization Schedule of Prenatal Mothers and Children in India

Pregnant Mother:
Tetanus Toxoid I Dose 3 Months
II/B Dose 4 to 6 weeks after the first dose

Infants and Children


Birth OPV Zero Dose
BCG
6 Weeks I Dose OPV
I Dose DPT
12 Weeks II Dose OPV
II Dose DPT
18 Weeks III Dose OPV
III Dose DPT
9 Months Measles/Mumps/Rubella (MMR)
16 to 24 Months Booster Dose DPT/OPV
5 to 6 Years DT
10 to 16 Years TT

LEVELS OF PREVENTION
There are four levels of prevention:
• Primary prevention
• Secondary prevention
• Tertiary prevention
• Primordial prevention
Prevention of Disabilities 17

Primary Prevention
This includes health promotional and specific protection measures.

Health Promotional Measures


• Health Education of the Community regarding prevention of disease and disabilities—
need, use, why, how and what of Immunization. Defluoridation of water, iodisation
of common salt, good nutrition, provision of perinatal care.
• Improvement of housing, provision of potable drinking water, sanitation facilities,
improved standard of living, etc.
• Avoiding certain drugs, unnecessary medication/exposure to X-rays during pregnancy.
• Better care during delivery, antenatal/postnatal/perinatal periods.
• Prevention of head injuries—using helmets and seat belts.
• Improvement in vehicle design and provision of medical facilities, stronger enforcement
of regulations concerning the compulsory use of seat belts (four wheel vehicles) and
helmets (two wheel vehicles) and restrictions on alcohol consumption and other substance
abuse combined with driving will mean greater chances of survival from road accidents
and these should therefore be encouraged.

Helmets/safety devices in occupational settings/road safety signals/usefulness of seat belts

Accidents and injuries are a major cause of disabilities. Multipronged approach is necessary. Road
traffic accidents, domestic accidents, industrial accidents, railway accidents burns are important
contributing accidents.
Studies by Dr G Gururaj et al of NIMHANS have proved beyond doubt need, necessity and inevitability
of use of helmets to prevent Road traffic accidents. Studies in Austria have proved beyond doubt
usefulness of seat belts.
While both human and environmental factors contribute to causation of accidents, human factor is most
important. Monitoring and surveillance of accidents and injuries, promotion of safety measures, alcohol
and other drugs, primary care, Elimination of causative factors, legislations, rehabilitation services and
accident research constitute measures for various levels of prevention.
Need of development of “Golden Hour Management” systems in cities and highways need no emphasis?
“Trauma Consortium” of Bangalore is an excellent example to address golden hour management.

Specific Protection Measures


• Immunisation against six killer diseases
• Defluoridation of water
• Use of iodized salt vit A prophylaxis
Essentially, primary prevention aims at aborting the onset of event like injury/disease
which may lead to disease/disability—effort which may take some time to be obvious—
but will reduce the burden of disability in a big way. Primary prevention programmes are
vital for both developed and developing countries. It is more so in developing countries
where childhood disabilities are prevalent even today.
18 Community Based Rehabilitation of Persons with Disabilities

Universal Salt Iodisation and Challenges


In areas where Iodine content of soil is low, Iodine deficiency disorders are common. This is specially
seen in sub-Himalayan regions of India. Often we find children in these areas to be slow learners. A
range of Iodine deficiency disorders starting from being slow learners to frank goitrous state is observed.
Some of the attempts towards prevention of Iodine deficiency disorders (IDD) include Iodisation of salt,
banning of sale of common salt, Use of long acting Iodine preparations UNICEF has supported
Government of India with establishment of Iodisation plants. Survey for Iodine deficiency disorders is
an important component of National Programme for Control of IDD.

Vitamin A Prophylaxis Programme


In India, 2 lakh International Units of Vitamin A is administered to children from 6 months to 6 years
to prevent Vitamin A deficiency which causes visual disabilities ranging from dryness of conjunctiva,
softening of cornea, corneal ulcer leading to blindness. The vitamin A concentrate is administrated in
liquid form/massive dose capsule containing 6 lakh units.
The programme is implemented through Anganwadi Workers of Integrated Child Development Services
(ICDS) scheme and Health Workers in India.

Secondary Prevention
Early diagnosis/early identification of disease and treatment/management of disease/
injury/event will help reduce occurrence of disability. Examples of this are: early
identification of “patches” due to leprosy and institution of prompt treatment will prevent
occurrence of disabilities.
Early recognition of vit A deficiency and prompt treatment, nutritional supplementation
will prevent occurrence of blindness due to vit A deficiency.
Screening for cataract and surgery will help people have better vision.
Identification, needed surgery, therapeutic measures will prevent contractures and
deformities in persons with paralysis due to poliomyelitis.

Tertiary Prevention
The above example of prevention of contractures and deformities due to post-polio residual
paralysis may be included under “disability limitation” instead of early diagnosis and
treatment.
“Disability limitation” and Rehabilitation come under tertiary prevention. In a country
like India where we see high prevalence of childhood disability, there is need to focus on
both primary prevention and early diagnosis and treatment with equal importance. Early
identification and early intervention will help prevention of further disabling conditions.
Disabilities and restrictions, needless to say “Rehabilitation” is also equally important in
a country like ours where more than 45 million people with disabilities live.
Approach of development of comprehensive health programmes is necessary for any
country. All facets of Health Promotion, specific protection, early diagnosis and treatment,
disability limitation and rehabilitation need to be simultaneously addressed in a developing
country like ours where the population is large and number of people with disabilities is
more.
Prevention of Disabilities 19

Childhood disabilities are more common in developing countries and disabilities due
to chronic illness and age is more common in developed countries. Disability prevalence
increases with age. Prevention of communicable diseases, improved nutrition, improved
maternal and child health care has reduced childhood disabilities in developing countries.
But, increased life expectancy and diseases of growing age have contributed to disabilities
in old age. In our country we have tackled communicable diseases to some extent and
increased our life expectancy also. We have still the challenge to face both communicable
and non-communicable diseases.

Primordial Prevention
Another important level of prevention is primordial prevention. This specifically helps us
prevent occurrence of diseases of hypertension, diabetes, coronary artery disease, stroke,
obesity, etc if intervene in early childhood, childhood and adolescence; prevents occurrence,
suffering and disabilities due to non-communicable diseases, especially if we change our
lifestyle. Health education and counselling on diet, physical activity and tobacco use at high
school level may help in attempting primordial prevention. Basically, primordial prevention
aims at risk factor prevention.

IMPLEMENTATION OF PREVENTION PROGRAMMES


There is need for better health infrastructure to implement prevention programmes. In our
country, the health worker (female) of the subcentre, Anganawadi worker of ICDS scheme
and primary school teacher constitute critical manpower for the implementation of many
preventive health programmes, e.g. immunization of children and antenatal mothers, vitamin
A prophylaxis, antenatal, intranatal and postnatal care, school health examination, etc.
Involvement of traditional dais, health worker (female), Anganawadi worker, teacher
will be vital for early diagnosis and early intervention for disabilities. This aspect will be
dealt in greater detail in Chapter 5. Primary prevention programmes are cost-intensive and
needs collaboration and help of various government, private, NGO and civil society
initiatives and inputs. There is need for this trisector collaboration to meet the needs of:
• Better housing
• Improved literacy
• Potable drinking water
• Defluoridation of water
• Prevention of accidents—domestic/road/occupational
• Iodisation of salt
• Improved perinatal care
• Poverty alleviation
• Needs of disabled people especially the poor, women, etc.
As discussed earlier, primary, secondary and tertiary measures are necessary and need
to be implemented in tandem. This is because of the number of disabled people we have
in our country. While preventive programmes help reduction of burden of disability in
future, there is need for “care” of people who are already disabled too—make them
20 Community Based Rehabilitation of Persons with Disabilities

functionally, economically, psychologically and socially independent and integrated into


the mainstream of the society. Needless to say—physiotherapists can play an important
role in this. It is impossible to have one physiotherapist in each of the 6,75,000 villages in
India at least in the near future, but it may be possible for each of you—students, would
be physiotherapists to transfer some of the professional skills to Anganawadi workers, health
workers, teachers, family members and persons with disability themselves, community
volunteers, community-based rehabilitation workers and involve them in community-based
rehabilitation activities, programmes. Early intervention has profound benefits in
rehabilitation. It becomes obvious when we look at the following example:
Brain growth will be complete—90 percent of times by 7 years of age, but Physical
growth will be complete only by 18-24 years of age. Fastest period in ones life is fetal period.
Thereafter, infancy, preschool, adolescence stands out to be faster periods of growth. If
a child is having hearing impairment, it is easier and most practical to intervene in early
childhood rather than later years. If a child has clubfoot, intervention is easier when he
is very young than at the age of ten. Early identification and early intervention is possible
only if we initiate development of physiotherapy skills and other therapy skills in grassroots
level workers mentioned above and family members and probably the physiotherapists
may focus on confirmation, assessment, advice and training inputs for this process.

Filariasis and Disability Prevention


One of the less intervened infectious diseases causing disabilities is Filariasis. Caused by Filarial worm
and transmitted by Culex species of mosquitoes lands a affected person in Elephantiasis 15 years
after the affection of disease first. Often person would have forgotten the initial infection.
Early diagnosis, prompt treatment, follow-up with blood smears and treatment can prevent disabilities
due to Filariasis in a big way.

Need for Prevention of Consanguineous Marriages


Practice of consanguineous marriages is to be discouraged. It is known in many studies that chances
of children born with disabilities especially mental retardation are common in consanguineous marriages
compared to non-consanguineous wedlock.
There is an increased risk in the offspring of traits controlled by recessive genes and polygenes, e.g.
Albinism, Alkaptonuria, Phenylketonuria, etc. Increased risk of premature death is also noticed.

Premarital Counseling
This is an important aspect of disability prevention. Prospective genetic counseling gives an opportunity
for disability prevention. This will be especially helpful in Sickle Cell Anemia and Thalassaemia.
Heterozygous individuals are to be identified and prospective individuals who will marry need to be
screened for heterozygotes.
Most often genetic counseling is retrospective. Genetic counseling is often sought in connection with
mental retardation, psychiatric Illness, congenital abnormalities and inborn errors of metabolism.
Indian Council of Medical Research (ICMR) has established Genetic Counseling centers across the
Country in various Medical Colleges. Two such centers are in St.John’s Medical College and MS Ramaiah
Medical College, Bangalore. World Health Organization suggests to Countries to establish Genetic
Contd...
Prevention of Disabilities 21

Contd...
Counseling Centres wherever diseases due to malnutrition and infectious diseases coming down and
where problems like Thalassaemia and Sickle Cell anaemia are highly prevalent.
Depending on culture and tradition of communities, contraception, sterilization and pregnancy termination
are advised in retrospective approach to genetic counseling.
Genetic counseling can have greatest impact only when prospective approach is made, i.e. before they
have developed symptoms themselves or before the affected child is born.
X-rays, Ionizing radiation and Chemical agents should be avoided during pregnancy and exposure
to gonads to be avoided al times.

Need for Intersectoral Coordination in Rehabilitation


Components of Primary Health care cannot be implemented by Health sector alone. This refers to
Disability limitation and Rehabilitation too. For effective rehabilitation measures in a community, there
is need for intersectoral coordination and collaboration is required between following departments for
disability prevention:
Agriculture, Animal Husbandry, Health and Family Welfare, Panchayatraj, Social Welfare, Women and
child Welfare, Public Works, etc. Intersectoral coordination helps in better planning, minimizing
duplication.

A good example of Intersectoral coordination is Integrated Child Development Services Scheme in the
country. For rehabilitation, such intersectoral coordination is attempted in District Rehabilitation Centre
Scheme, National Programme for Rehabilitation of Persons with Disabilities and Grameena Punarvasa
Yojana of Government of India. Intersectoral coordination is needed at Policy level, at District level, at
Field level between Health Workers, Anganawadi Workers, Teachers, NGOs, and local Community.

CBR and Primary Health Care:


Ashakirana Community Based Rehabilitation (CBR) initiative is an attempt made by the Department
of Community Medicine of MS Ramaiah Medical College Bangalore to integrate rehabilitation efforts
through Primary Health Care in its field practice area of Kaiwara Primary Health Centre, Chintamani
Taluk, Kolar District, Karnataka, India This is in collaboration with WHO, SEARO.

ASSIGNMENT FOR STUDENTS


1. Preparation of a chart of immunization schedule for children, pregnant mothers.
2. Preparation of a chart indicating vitamin A prophylaxis schedule.
3. Preparation of a chart listing milestones of development in children.
4. Observing children in their home/neighborhood surroundings.
5. Participation in a immunization programme in slums/villages.
6. Participation in a nutrition demonstration programme in a PHC/UFWC.
7. Participating in a prevention programme for road safety and traffic accidents.

BIBLIOGRAPHY
1. Clark and Leavell “Public Health Administration”.
2. Einar Helander “Prejudice and Dignity “UNDP, New York.
3. Hobson and Hobson “Preventive Medicine and Public Health” UK.
4. Park K “Text Book of Preventive and Social Medicine “Banarasidas Banot (Publishers), Calcutta.
Disability
4 Identification
IDENTIFICATION OF DIFFERENT DISABILITIES
Identification and needs assessment of persons with disabilities; surveys/records/key
informant inquiries/participatory rural appraisal/conduct of surveys.

LEARNING OBJECTIVES
At the end of session of three days, the participants should be able to:
• Understand and able to identify persons with common disabilities
• Conduct a disability survey and make needs assessment, prepare a short report.

OUTLINE OF CONTENT
• Methods of identification of persons with locomotor disabilities
• Methods of identification of persons with visual disabilities
• Methods of identification of persons with hearing impairment/speech problems
• Methods of identification of persons with mental retardation
• Methods of identification of persons with epilepsy
• Methods of identification of persons with leprosy
• Preliminary steps in initiating community based rehabilitation initiatives
• Village records, key informant survey
• PRA in disability work
• Survey methods

PRE/POST EVALUATION
• How to identify different disabled conditions?
• How to do needs assessment?
• How to conduct a survey of disabled persons?
• What is community diagnosis?
• Who are key informants?
• What is PRA?
Disability Identification 23

SUGGESTED METHODOLOGY FOR TRAINING


The institution is suggested to develop a CBR programme in its field practice area/develop
a field practice area. This can be done in collaboration with local govt/NGO.
Survey be done over a period of three days and in the process, train the students in
disability identification, survey, report writing.
The document of Maya Thomas and Pruthvish S “Identification and needs assessment
of beneficiaries in community based rehabilitation initiatives” Monograph Published by
ActionAid India (1993) will be helpful for the exercise.
Identification of persons with disability, assessing their needs, assessing and accessing
local/external resources, training and education of community resource, disabled persons,
their family members, creation of awareness among community members, organizing
disabled people, their family members constitute some of the preliminary steps in initiating
community-based rehabilitation activities. In this chapter, methods of identification of
different disabilities are described. In the latter part, conduct of community surveys is dealt
in detail.

Questions for use in Identifying People with Disabilities (WHO)


People who have Difficulty in Seeing
Is there a person in the family
• who cannot see as well as the others?
• who cannot see well when it is dark?
• who cannot see objects that are far away, such as trees or birds?
• who cannot see objects that are very close, such as seeds held in his or her hands?
• whose eyes look very different from other peoples’?

People who have Difficulty in Hearing or Speaking


Is there a baby in the family who does not make sounds?
Is there a person in the family who
• has difficulty in hearing what others say?
• cannot understand what others say?
• cannot speak?
• cannot speak clearly enough to be understood?

People who have Difficulty in Moving


Is there a person in the family
• who has difficulty in moving part of the body, such as the arms, legs, back, or neck?
• whose arms, legs, back or neck are weak?
• who has a great deal of pain in the arms, legs, back, or neck?

People who have no Feeling in the Hands or Feet


• Has any person in the family lost feeling in either the hands or feet or both?
• Does any person in the family injure or burn his or her hands or feet often?
24 Community Based Rehabilitation of Persons with Disabilities

People who show Strange Behaviour


• Has anyone in the family changed so much that now he or she behaves like a different
person?
• Does the person not talk to anyone any more?
• Does the person talk much more than before?
• Does the person become excited or angry for no reason, or frighten other people?
• Does the person hear voices that other people do not hear or see things that other people
do not see?
• Has the person stopped keeping clean?
• Has he or she stopped dressing properly?
• Does the person speak or move around in a strange way?

People who have Fits


• Does any person in the family have fits?

People who have Difficulty in Learning


• Is there a child in the family who cannot learn to do things that other children of the
same age do?
• Is there a child who, when compared to other children, has been slow in learning to
sit up, stand, walk, speak, eat, or dress?
• Is there a child in the family who has not learned to do these things at all?
• Does any person appear to be backward, dull or slow when compared to others of the
same age?
• Is there an adult who does not do the things that other adults do?

Questions for use in Assessing a Person with a Disability (WHO)


• Feeds himself or herself?
• Keeps himself or herself clean?
• Uses the latrine?
• Dresses and undresses?
• Understands simple instructions?
• Expresses needs?
• Understands movements and signs for communication?
• Uses movements and signs for communication which others understand?
• Lip reads?
• Speaks?
• Sits?
• Stands?
• Moves inside the home?
• Moves around the village?
Disability Identification 25

• Walks at least 10 steps?


• Has aches or pains in the back or the joints?
• Breast-feeds and grows like other babies?
• Plays like other children of the same age?
• Goes to school?
• Joins in family activities?
• Joins in community activities?
• Does household activities?
• Has a job or has an income?

President of the Menninger Foundation, Topeka, Kansas, USA - William C Menninger drew up following
questions to help measure one’s on Mental Health status: According to Dr. Menninger, help is necessary
if answer is “Yes” to any of the questions:
1. Are you always worrying?
2. Are you unable to concentrate because of unrecognized reasons?
3. Are you continuously unhappy without justified cause?
4. Do you loose your temper easily and often?
5. Are you troubled by regular insomnia?
6. Do you have wide fluctuations in your moods from depression to elation, back to depression
which incapacitate you?
7. Do you continuously deslike to be with people?
8. Are you upset if routine of your life is disturbed?
9. Do your children continuously get on your nerves?
10. Are you “browned off” and constantly bitter?
11. Are you afraid without real cause?
12. Are you always right and the other person always wrong?
Do you have aches and pains for which no doctor can find a physical cause.

How to Identify Children who have Difficulty in Moving?


Ask the Child to do the following activities
• Move the arms above the head, and then place them behind the back.
• Place a cup or plate in front of the child and ask the child to pick it up.
• Place a small object on the ground and ask the child to squat or bend and pick it up.
See whether the child does this in the same way as the other children of the same age.
If there is any deviation, one may suspect difficulty in movement.
Children who have difficulty to see/who have strange behavior may not be able to do
as instructed. One may consider presence of other disabilities too—for which the child may
need help.

How to Identify Children who have Difficulty in Seeing?


Children under 4 years, but above three months of age
Hold a torch at a listance of 10 to 12 inches in front of the seated child and move it from
one side to another side. Normally, eyes of the child will follow the torch. If the child’s
eyes do not follow the torch, repeat the test 2 to 3 times. When you are sure that the child
does not follow the torch, child has difficulty to see.
26 Community Based Rehabilitation of Persons with Disabilities

Children above 4 years


Stand at a distance of three meters in front of the child. Hold three fingers of one hand
and ask the child to count/hold his hand too similarly. If the child cannot do this, he/
she probably has difficulty to see. Find out whether child has difficulty seeing in the dark
or seeing in the evening/drops things/finds difficult to find things in dark—in the evenings.
If yes, one may suspect night blindness—which is early sign of vit. A deficiency.

Older Children and Adults


Thorough examination with Snellen’s chart—English/Hindi/Local language/E charts if not
literate will be useful. While this is for distant vision, for near vision—near vision charts
are available.

How to Identify Children with Hearing Problems?


Child 0 to 3 Months
• New born is not startled in response to a loud clap within 3 ft.

Child 3 to 6 Months
• Baby does not search for source of sound with eyes.
• Baby does not respond to cooing/talk by parents.

Child 6 to 10 Months
• Baby does not respond to name. Ringing bell, or someone’s voice.
• Baby does not understand simple phrases like—no-no; bye-bye, etc. in local language

Child 10 to 15 Months
• Child cannot point to familiar objects or people.
• Child does not imitate simple sounds or words.
• Child does not respond to no-no or name unless he/she sees the speaker.
• Child shows no interest in radio.

Child 15 to 18 Months
• Child does not follow simple directions.
• First words—no/no; go/go; bye/bye in local language not developed.

Child 16 Months to 3½Years


• No noticeable in child’s vocabulary.
• Child uses gestures almost exclusively to convey need and desires instead of speaking
Child does not enjoy listening to stories.
• Child has history of earaches and ear infections.
Disability Identification 27

Child Appears Disobedient


(Child 3½ to 5 years)
• Child cannot locate source of sound.
• Child cannot understand and use simple words such as go/me/in/big, e.g. in local
language.
• Child cannot give an account of recent experience.
• Child cannot carryout two simple directions one after another.
• Child cannot carry on a simple conversation.
• Child’s speech is difficult to understand.

If the Child is School Going


Has trouble paying attention/does not answer when called/gets confused about directions
or does not understand them at all/frequently gives wrong answers to questions/not doing
well in school and appears slow/confused expression when questioned or directions are
given/poor speech, substitutes sounds, omits sounds, has poor voice quality/avoids people,
plays alone, seems resentful or annoyed/gets tired earlier in the day, seems restless or
strained/turns one side of his head towards sound—indicating hearing loss in one ear/
frequent colds, earaches.

For Children below 5 Years


If the child is above 5 years of age, let the child sit on mother’s lap/make the child sit
on ground. Hold something interesting in front of the child and seek attention of the
child. Go behind the child; hold your hands 3 cm above child’s head in such a way that
the child does not see your hands. Now ask another person to watch child’s eyes. Clap
your hands above the head of the child ensuring that no distracting sounds are there—
nearby.
If the child can hear, he/she will blink just after you have clapped/or child will turn
its head to look at you.
Repeat three times to make sure.
Try the test using different sounds such as a bell/drum. If the child does not blink or
turn the head, child probably has difficulty to hear. Rattle may be useful for testing.

Children above 5 Years and Adults


You can use the same technique as above or you can also use the counting test. Ask the
child to sit about 3 meters in front of you. Tell the child that you are going to say few
numbers like one/two/three/four and you want him to repeat them or hold out the same
number of fingers you called. Then you should say four different numbers hiding your
mouth.
Now you ask the child to repeat them or hold up that much number of fingers. If he/
she is able to do so correctly, then there are no hearing problems. If the child is unable
to repeat what you say, speak loudly. If the child is still unable to hear what is loudly
28 Community Based Rehabilitation of Persons with Disabilities

said at 3 meters, then the child has difficulty hearing. You could also do the test for children
under 6 to make sure.
Watch test and use of tuning fork to differentiate types of hearing loss will be useful
in older children and adults. Audiometry will be the confirmatory test; as well it will help
differentiate degree of disability too.
If a child even at the age of 15 months is not able to talk two word sentences, one must
suspect:
• Nothing/hearing loss/mental retardation.

Screening Schedule for Mental Retardation


Screening Schedule 1
Children below 3 years: See Table 4.1

Table 4.1: Screening schedule for children below 3 years

Stage No. Child’s progress Normal development Delayed development

1. Responds to name/voice 1-3 months 4th month


2. Smiles at others 1-4 months 6th month
3. Holds head steady 2-6 months 6th month
4. Sits with support 5-10 months 12th month
5. Stands with support 9-14 months 18th month
6. Walks well 10-20 months 20th month
7. Talks in 2/3 sentences 16-30 months 3rd year
8. Eats/drinks by himself 2-3 years 4th year
9. Tells his name 2-3 years 4th year
10. Has toilet control 3-4 years 4th year
11. Avoids simple hazards 3-4 years 4th year

Other Factors
• Has fits Yes/No
• Has Physical disability Yes/No
• If the child is found to be delayed in any of the stages given from1-11 a
nd if the child has fits or physical disability, suspect mental retardation.

Screening Schedule 2 (3-6 Years)


Observe the Following
• Compared to other children, did the child have any serious delay in
sitting/standing/walking? Yes/no
• Does the child appear to have difficulty in hearing? Yes/no
• Does the child have difficulty in seeing? Yes/no
Disability Identification 29

• When you tell the child to do something, does the child seem to
have problems in understanding what is being said? Yes/no
• Does the child sometimes have weakness/stiffness in the limbs,
difficulty in walking/moving the limbs? Yes/no
• Does the child sometimes have fits, become rigid or lose consciousness? Yes/no
• Does the child have difficulty in learning to do like the children of
his/her age? Yes/no
• Is the child not able to speak at all? (To make himself understood in words
or to say any recognizable words. Yes/no
• Is the child’s speech in any way different from normal? (Not clear enough
to be understood by people other than his immediate family. Yes/no
• Compared to other children of the same age, does the child appear in
any way backward, dull or slow Yes/no
If any of the above items elicits ‘yes’ as an answer, suspect mental retardation.

Screening Schedule 3 (7 years and above)


Observe the Following
• Compare to other children, did the child have any serious delay in
sitting, standing or walking? Yes/no
• Is the child unable to do things for himself like eating, dressing,
bathing and grooming? Yes/no
• Does the child have difficulty in understanding when you say do
this or that? Yes/no
• Is the child’s speech unclear? Yes/no
• Does the child have difficulty in expressing what he has seen or heard,
ithout being asked? Yes/no
• Does the child have weakness or stiffness in the limbs or difficulty in
walking or moving his arms? Does the child sometimes have fits,
become rigid or lose consciousness? Yes/no
• Compared to other children of his age, does the child appear in
any way backward, dull or slow? Yes/no
If any of the above items elicits ‘yes ‘ as an answer, suspect mental retardation.

How to identify Epilepsy?


• Unusual or repeated movements of face or head.
• Contractions or twitching of muscles especially those of the arms and legs.
• Purposeless sounds and body movements.
• The person becomes unconscious.
• Staring or day dreaming.
• Rolling of eye balls.
• Heads rolls about loosely.
30 Community Based Rehabilitation of Persons with Disabilities

• Drooling of saliva.
• Uncontrolled passing of urine and stools.
• In a severe fit, the person suddenly falls, often with little or no warning, and may make
a strange cry. This can frighten people.
• At first, the body becomes stiff and then loose.
• The arms and legs make unusual movements, which can be vigorous. Froth and bubbles
of saliva may appear at the mouth and may be colored red by blood if the person has
bitten his tongue or cheeks.
• People who see this happening sometimes find it upsetting and are afraid. This is quite
natural.
• A fit may last only a few seconds, or a few minutes. The person is not in pain and his
life is not in danger unless he is in the way of traffic, in water or falls near fire.

How to identify Leprosy (Hansen’s disease)?


Leprosy, in a majority of instances can be identified only on the basis of a proper inspection.
• A thorough inspection of the body surface (skin) to the extent permissible in good natural
light for the presence of tell tale evidence of leprosy.
• Feeling the commonly involved peripheral nerve for the presence of thickening/and or
tenderness, e.g. Inner part of the elbow, behind the ear, outer part of the knee, outer
part of the ankle, etc.
• Testing for loss of sensation of pain (using a skin needle) or light touch (e.g. wisp of
cotton wool).
• Deformities like paralysis of muscles of hand and feet, claw hand, loss of fingers or
toes, foot drop, claw toes and other deformities.
• If there is a doubt in diagnosis, refer the person to the nearest health facility and follow-
up.

Preliminary Steps in Initiating Community-based Rehabilitation Activities


Identification of persons with disability, assessing their needs, assessing and accessing local/
external resources, training and education of community resource, disabled persons, their
family members, creation of awareness among community members, organizing disabled
people, their family members constitute some of the preliminary steps in initiating
community-based rehabilitation activities.
It is essential that we understand the social, cultural, demographic and economic profile
of the community, make a community diagnosis before we intervene. It may be a good
idea to consider following approaches to collect preliminary data:

Village Level Records and Information from Key Informants/Functionaries


One may refer to records of Anganawadi workers (grassroots level workers of ICDS scheme)
and find out list of disabled people/children she may have. One may consult primary school
teacher/high school teacher/panchayat member/secretary of the village and enquire from
them any disabled people in the village? Another good approach can be talking to traditional
Disability Identification 31

Useful questionnaire for identification of disabilities


Questionnaire A
A. (a) Does anybody in your house have difficulty
to read (visual impairment) Yes / No
to hear (speech and hearing disabilities) Yes / No
to talk (speech and hearing disabilities) Yes / No
to stand (locomotor disabilities) Yes / No
to walk (locomotor disabilities) Yes / No
to kneel (locomotor disabilities) Yes / No
(b) Does anybody in your house have
History of fits (epilepsy) Yes / No
History of strange behaviour (mental illness) Yes / No
c) Does anybody in your house have inability to understand
what they see/hear/touch/smell/taste (mental retardation) Yes / No
and/or responds slowly to what others say and to what
happens in their surroundings (mental retardation) Yes / No
d) Does anybody in your house have Hansen’s disease (Leprosy) Yes / No
e) Any other persons with problems-related to disability not listed above Yes / No
If yes, details ____________________________________
B. Do the disabled persons identified have more than one disability ? Yes / No
If yes, details ____________________________________
Source: Maya Thomas and Pruthvish S “Identification and needs assessment of beneficiaries in
community-based rehabilitation initiatives” Monograph Published by Action Aid India, Bangalore (1994).
Questionnaire B
Useful Questionnaire for identification of disabilities in under five children
C. If the family has children under 5 years, the interviewer should specifically ask each mother the
following ten questions:
1. Compares with other children, did the child have any serious delay in sitting, standing or walking?
2. Does the child speak at all?
3. Can did child make himself understood in words : can he say recognizable words?
4. Does the child have difficulty in seeing ?
5. Does the child have any difficulty in hearing ?
6. When you ask the child to do something, does he seem to understand what you are saying?
7. Does the child have any weakness and/or stiffness in the limbs and/or difficulty in walking
or moving his arms?
8. Has the child often had fits, become rigid or lost consciousness in the last six months?
Has the child had any other serious accident or illness?
9. Compared with other children of his/her age, does the child appear in any way backward,
slow or dull?

Name of the child Age Sex If ‘Yes’ is the response to questions 1, 4, 5, 7 to 10,
and ‘No’ to questions 2,3 and 6 details of
problems identified
1.
2.
3.
4.
Source: Maya Thomas and Pruthvish S “Identification and needs assessment of beneficiaries in
community-based rehabilitation initiatives” Monograph Published by Action Aid India , Bangalore (1994).
32 Community Based Rehabilitation of Persons with Disabilities

trained/untrained dais who normally get involved in conducting of deliveries/health


worker of the area. Talking to formal/informal leaders of the village may be worthwhile.
Much information may be gathered this way and may be sufficient to initiate community-
based rehabilitation work. One may consider detailed survey at a later stage when it is
certain that resources are available to include all disabled people in the community.

Participatory Rural Appraisal


One of the approaches followed by development projects has been participatory rural
appraisal for development work. CBR initiators like Mr KR Rajendra, Mr Somesh from India
have tried out these methods and approaches to identify disabled people, prepare their
mobility sphere, find out their needs, and evaluate the programme too. They essentially
involve the community and disabled people in the process and try developing ownership
of the programme by the community from the beginning itself.
PRA is the best available non-verbal communication system that builds on available local
knowledge and practices, especially when dealing with non-literates. PRA techniques have
enhanced community participation, and thus people with disabilities have a say in decision-
making.
Mobility mapping is one of the tools used to assess the needs of a locomotor disabled
person. A disabled person will be motivated to draw the rough sketch of his/her village,
with some help from family/community members. The person will map mobility patterns
using the village map drawn on the ground. This activity enables us to assess the residual
potential of the person, his/her exact mobility pattern, constraints he/she has in going to
the toilet/school/friend’s house/play ground, etc. Also, it is a broad indicator of the kinds
of interventions that need to be planned for the individual, family and community to gain
better access to education, training and income generation and better social acceptance.

Survey Methods
The formulation of an effective Community-based Rehabilitation Programme begins with
defining the magnitude of the problem of disability in the community. Although costly and
time consuming, identification surveys are much cheaper than intervention itself. The survey
may suggest that the problem is far less than originally anticipated, and may also suggest
how rehabilitation activities (organizing disabled people, their family members, medical
and surgical treatment, physiotherapy, speech therapy, occupational therapy, activities of
daily living skills, vocational training, job placement, maintenance allowance, other social
security measures, recreation, leisure activities) can be planned.
Also, the survey may identify the types of disabilities and those peculiar to the
geographical setting (urban/rural/tribal).
A systematic and comprehensive preliminary investigation should preferably include the
following:
a. Awareness programmes in the community using locally familiar/popular media and
audio-visual presentations to create awareness among the people of the proposed
interviews and surveys. Various aspects of disability may be covered in these
Disability Identification 33

programmes using handbills, video films, posters, etc. Local organizations such as
schools, health centers and so on should also be involved. It is important to assure and
ensure that services would be linked with the survey.
b. Collection of information from census reports of the villages/slums/tribes. Contacting
officials of departments of economics and statistics, social welfare, development and
panchayat, disabled welfare and non-governmental organisations working in the area
will be an additional help.
c. Interviews using structured questionnaire conducted with those individuals likely to be
aware of the problem, e.g. formal and informal leaders, local functionaries of education,
health, panchayat, social welfare, etc. traditional dais, elderly members of the community,
Anganawadi and Balwadi (preschool teachers) workers, members of mahila mandals
(women’s groups) and youth organizations, rehabilitation centers and special schools
(if any).
d. Identification (prevalence surveys) determines the number of individuals in the sample
(or the whole population surveyed) with a particular impairment, disability and handicap
at that point of time. When this represents the population under consideration, the
prevalence rates within the sample represent the prevalence within the population as
well.
e. Surveys involving assessment (at least preliminary assessment) components are the most
efficient and definitive (unbiased means) of:
• Establishing the nature, magnitude and geographical distribution of different
disabilities.
• Determining whether it manifests itself as a significant public health problem.
• Selecting suitable strategies for intervention.
• Providing a baseline for evaluating the effectiveness of future intervention
programmes.
• A survey of the entire population in the chosen target area will give more accurate
result.

Personnel and Field Level Activities


It may be a good idea to include total population covering both sexes and all age groups
in the survey. Anganawadi workers, health workers, teachers, local youth, student
volunteers may be involved in the survey. It may be a good idea to involve people who
will be delivering the services. Personnel with metric/pre-university background will be
able to do the survey and it may be a good idea to have person with master of social work
background to coordinate design planning, implementation and analysis of survey. Services
of a statistician if available, may be utilized.
Training of survey personnel is of utmost importance. It is advisable that all personnel
involved in the survey undergo adequate training and orientation.
Field practice can begin slowly, with one enumerator interviewing a family whilst other
observes. This is one way of overcoming reticence and learning from another’s mistakes.
As their confidence and skill levels increase, the staff can interview families on their own,
under the supervision of the survey coordinator.
34 Community Based Rehabilitation of Persons with Disabilities

Enumerators need to visit each house in the cluster and keep a careful record of those
that are unoccupied, do not have disabled persons, or have disabled persons who are not
present at that time or where parents refuse to cooperate. Such data are important to
evaluate results or bias. If large number of families with disabled persons is away in the
fields or refuses to cooperate, it is reasonable to surmise that their characteristics and risk
of disability might be different from those of families that were interviewed.
If the houses are found locked, repeat visits should be made either early in the morning
or late in the evening (depending on the occupation of local people). Information can be
collected from neighbors if repeat visits also fail.
Uniform case definitions are to be evolved and used by all the enumerators.
If cases of leprosy are identified, they should be referred to a nearby government health
facility. Cured/arrested cases of leprosy with physical deformities may be referred for
rehabilitation on a case-by-case basis. Disabilities that might have resulted from untreated
leprosy may also be considered for rehabilitation.
The supervisors must check the accuracy of the enumerators by reinterviewing at least
10 percent of households, checking the needs assessment of all people with disability and
participating in the analysis of data. All proformae used should be reviewed at least twice
for legibility, accuracy, and completion before entry into computer. Special edit programmes
should check computer entry.
Interview techniques should be standardized, and poor quality unenthusiastic workers
should be replaced. It is advisable to devote one day every week for data entry into master
charts so that data collection and compilation end almost simultaneously.
A summary report must be prepared for each village/slum/tribal area and a consolidated
report compiled there from. The report should specifically touch upon:
a. Facilities of health, formal and informal education, vocational training, job placement,
self-employment that are locally available.
b. Other organizations—Govt./NGO working in the area with whom collaboration is
possible.
c. Leaders who could be involved to generate community involvement and participation
in CBR work.
d. Approximate number of persons with disabilities.
e. Needs assessment of persons with disabilities.
Undertaking identification and needs assessment survey ultimately helps in making a
community diagnosis of the problem of disability. Once this is complete, intervention needs
to be planned in consultation with other members in the team. A community diagnosis
helps in proper budgetary expenditure and makes best use of available resources. The first
step towards intervention will be detailed assessment of individual persons with disability.
One may develop a home-based record for monitoring and evaluation from this stage.

ASSIGNMENT FOR STUDENTS


Students under the guidance of faculty are suggested to conduct survey in a village/slum
population.
Students conduct “case study” of at least 5 persons with disability/ies.
Disability Identification 35

BIBLIOGRAPHY
1. Dept. of Disabled Welfare, Govt. of Karnataka (1992) Survey report, Schedules and guidelines used for statewide
disability survey in the State of Karnataka.
2. Dept. of Social Welfare, Govt. of Madhya Pradesh (1996) Survey report, Schedules and guidelines used for
statewide disability survey in the State of Madhya Pradesh.
3. Einar Helander “Prejudice and Dignity“ UNDP.
4. ICMR Center for Advanced Research on Community Mental health “features of mental disorders” Department
of Psychiatry, NIMHANS, Bangalore, India 1988.
5. Joseph Abramson “Survey Methods in Community Medicine”.
6. Larson H (Ed) “Childhood Disability Information Kit“, UNICEF Katmandu, Nepal, 1983.
7. Maya Thomas and Pruthvish S “Identification and needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives“ Monograph Published by ActionAid India (1993).
8. Minaire P “The use of International classification of Impairments, Disabilities and Handicaps (ICIDH) in
rehabilitation” Strabourg, Council of Europe, Publications and Documentation Division, 1989.
9. National Institute for Mentally Handicapped “Mental retardation—A manual for Village Rehabilitation Workers”,
Secunderabad, India, 1988.
10. NSSO (GOI) A report on Disabled Persons 47th round, July to Dec 1991 Report No. 393.
11. Pahwa A (Ed) Manual on Community Based rehabilitation District rehabilitation Centre Scheme, Ministry of
Welfare, Government of India, New Delhi, 1990.
12. Park JE and Park K “Text book of Preventive and Social Medicine “Banarasidas Banot, Calcutta, 1989.
13. Rajendra KR “Application of PRA in Therapeutic interventions in rehabilitation“ ActionAid Disability News
Vol.10 No 1 and 2, 1999.
14. “Sarvekshana” Journal of Sample Survey organization, dept. of Statistics, ministry of Planning, New Delhi
Vol VII No 1-2 1983.
15. World Health Organisation WHO/RHB/96.3 Guidelines for Conducting, Monitoring and self assessment of
Community Based Rehabilitation.
16. World Health organization “Training in the Community for people with Disabilities“ Geneva 1989.
Early Identification
and Early Intervention
5 for Disabilities
LEARNING OBJECTIVES
At the end of the session, the participants should be able to:
• Observe children and observe milestones of development
• Recall milestones of development; use development checklist
• Appreciate need and usefulness of early identification and early intervention
• Appreciate the need for involving parents/grassroots staff in early identification and
early intervention

OUTLINE OF CONTENT
• Tips for early identification of disabilities
• Development check lists, child guidance clinics
• Need for skill transfer to grassroots
• Perspectives of UNICEF and UNESCAP
• Development milestones.

SUGGESTED METHODOLOGY
• Review of milestones of development of normal children
• Review Denver scale/Bayley’s scale
• Lecture/discussion
• Task analysis of children under 6 in special schools/select children in pre-schools/
Anganawadis.

PRE/POST EVALUATION
• What are normal milestones of development?
• Can we involve parents? Grassroots in development screening?
There are an estimated 12 million disabled children in India. Yet, the subject of childhood
disability has been neglected. Early detection is essential as early intervention is the most
beneficial. It is now accepted that intelligence is not genetically fixed, but can be significantly
influenced by the environment, especially in early childhood.
Early Identification and Early Intervention for Disabilities 37

Understanding normal development and its variants is important. Sometimes it may be


difficult to arrive at diagnosis and one may need to initiate intervention. But, knowing
diagnosis will help to counsel parents. Experience has revealed that by the end of first year
of life, most of the impairments can be detected and any persisting impairment must be
looked at carefully and should be considered as significant needing intervention.
Mild mental retardation and learning disabilities are often not detected till school age.
It may be useful to detect early—before school entry since impact on physical and mental
health will be significant. Developmental examination of children will help evaluate the level
of development achieved by the child at different ages and to identify delay/deviations
from the normal. Talking to parents, structured observations and conducting specific
examinations and tests/tasks will help assessment and diagnosis. It is ideal if a team
consisting of pediatrician, psychiatrist, clinical psychologist and social worker can do this.
Child guidance clinics attempted in certain places try to do this.
While repeated observations are necessary to draw conclusions, following are certain
indicators:
• Persistent asymmetry of tone/posture/movement and reflexes
• Exaggerated tendon reflexes with persistent clonus
• Extensor plantar response after early infancy
• Persistent excessive extensor tone and opisthotonus—as early indicator of cerebral palsy
• Constant fisting
• Stereotyped, repeated and identical movements and abnormal movements, e.g. frequent
jerking, incessant chewing
• Persistent lack of alertness after 6 months
• Squint, lack of visual following nystagmus, roving eye movements persisting after 6
months
• Parental suspicion about possible hearing loss
• Infants with kernicterus, amino glycoside administration, intrauterine infections, family
history of hearing impairment
• Club foot
• Deformed lip/ear.
Hearing aids can be fitted even in infants. Earlier the hearing defect is corrected, better
it is. Cochlear implants are also available in our country. The Bayle scale of infant
development (BSID) and Denver Developmental Screening Test (DDST) are mostly used
development screening tests.
Early identification should be done widely at hospital/health center and community level
and simple reliable methods applicable at community level are needed.
WHO and UNICEF have used disability questionnaires at the community level.
Integration of child development component with health aspects is necessary and ICDS
(Integrated Child Development Services Scheme) is the best example.
An attempt has been made to include developmental checklist in under-five card and
involve Anganawadi workers in early identification and early intervention of disabilities
in select districts in South India by UNICEF.
38 Community Based Rehabilitation of Persons with Disabilities

Use of milestones of development applicable to respective communities and parental


observation; observation by traditional Dai/anganawadi worker/health worker will help
identify many delays and deviations. Confirmation by doctor at PHC/CHC/district hospital
will be very valuable. Training of mothers (parents) and grassroots workers—Anganawadi
workers, traditional dais, and teachers—plays a very important role.

Suggested Policies and Programmes—UNICEF’s Perspective


To prevent disabilities from becoming handicaps and to advocate for effective therapy and
rehabilitation, early identification needs to be expanded and strengthened.
For normal growth and development of children who are already disabled, early and
continued therapeutic intervention, necessary assistive devices, prosthetics, education and
rehabilitation services are essential.
Collaboration with governments, UN agencies, NGOs and civil society, especially in CBR,
inclusive education, preparation for employment, sports and recreation for physical
development, need to be expanded.
Capacity building and resource mobilization: there is a great gap in the area of
rehabilitation and different forms of physical therapy, as well as a need for assistive devices,
teaching materials and training resources.
There is also great need for collaboration at the family and community level for better
use of resources.

Excerpts from UNESCAP Reports


Situation analysis and data collection: Accurate data on the magnitude, prevalence and types
of disabilities among children is essential for programme planning and implementation.
National census and surveys should include information on childhood disabilities.
Inclusive education and vocational training: Approximately 98% of children with disabilities
have no access to schools. Education, social integration and preparation for a productive
life of youth with disabilities need priority attention.
Public education and advocacy: Children and persons with disabilities are stigmatized and
negatively portrayed in many societies, even by the official media. Media campaigns should
emphasize the potential contribution of children with disabilities.
Early intervention, including early detection and identification during the first four years
of life, is particularly critical for infants with disabilities and their families. Failure to provide
intervention and support to parents and caregivers, results in secondary disabling
conditions, which further limit the child’s capacity to benefit from educational opportunities.
This is an area where multisectoral collaboration is essential, involving health, education,
and social welfare and community development.
Early Identification and Early Intervention for Disabilities 39

Milestones of Development in Indian Children


Table 5.1: Motor and language development
Age Motor development Language development
6-8 weeks
3 months Hold head erect
4-6 months Listening
6-8 months Sits without support Experimenting with Noises
9-10 months Crawling Increasing range of Sounds
10-11 months Stands with support First words
12-14 months Walks wide base
18-21 months Walks narrow base Joining words together beginning to run
24 months Runs Short sentences

Table 5.2: Adaptive and socio-cultural development


Age Adaptive development Socio-cultural development
6-8 weeks Looks at mother, smiles
3 months
4-6 months Begins to reach Recognizes mother, out for objects
6-8 months Transfers objects Enjoys hide and seek, hand to hand
9-10 months Releases objects Suspicious of strangers
10-11 months
12-14 months Builds
18-21 months Begins to explore
24 months Day by day

Cognitive/Developmental Assessment Tools


Bayley Scales of Infant Development, Second Edition (Bayley, 1993): The Bayley scales is an individually
administered instrument for assessing the development of infants and very young children. It is
appropriate for children from 2 months to 3½ years. It is comprised of three scales, the Mental Scale,
the Motor Scale, and the Behavior Rating Scale. The Mental Scale assesses the following areas:
recognition memory, object permanence, shape discrimination, sustained attention, purposeful
manipulation of objects, imitation (vocal/verbal and gestural), verbal comprehension, vocalization, early
language skills, short-term memory, problem-solving, numbers, counting, and expressive vocabulary.
The Motor Scale addresses the areas of gross and fine motor abilities in a relatively traditional manner.
The Behavior Rating Scale is used to rate the child’s behavioral and emotional status during the
assessment. Performance on the Mental and Motor Scales is interpreted through the use of standard
scores (mean = 100; standard deviation = 15). The Behavior Rating Scale is interpreted by the use
of percentile ranks. The Bayley Scales were standardized using a stratified sample of 1,700 infants
and toddlers across 17 age groupings closely approximating the U.S. Census Data from 1988. The
manual includes validity studies and case examples. The Bayley Scales is one of the most popular
infant assessment tools. It can also be used to obtain the developmental status of children older than
3½ who have very significant delays in development and cannot be evaluated using more age-
appropriate cognitive measures (e.g. a 6-year-old with a developmental level of 2 years).
For More details, please contact:
CBR NETWORK (South Asia),
134,1st Block,6th Main,BSk III stage Bangalore-560085, India
Phone-80-26724273, 26724221, 26724174
e-mail-cbrnet@vsnl.com
Website:http:\www.cbrnetwork.org.in
40 Community Based Rehabilitation of Persons with Disabilities

ASSIGNMENT FOR STUDENTS


Visit special schools for children of different disabilities and observe children under 6; do
task analysis of select children

BIBLIOGRAPHY
1. Park K, “Text Book of Preventive and Social medicine” 7th Edition, Banarasidas Banot (Publishers) Calcutta!.
2. Website of UNICEF.
3. Website of UNESCAP.
Concept, Principles,
Components of
Community-based
6 Rehabilitation
LEARNING OBJECTIVES
Students must be
• Able to differentiate Institution-based rehabilitation, outreach programmes and
community-based rehabilitation programmes
• Able to define community-based rehabilitation; list principles and components of
community-based rehabilitation
• Able to list needed logistic measures for initiating community-based rehabilitation
programmes.

OUTLINE OF CONTENT
• Institution-based rehabilitation; Outreach Programmes; Governmental Effort
• Definitions, Principles mooted by World bodies
• Examples of community-based rehabilitation programmes in India

SUGGESTED METHODOLOGY
• Posting in a community-based rehabilitation project/field programme for one month—
in a government/NGO set-up.

PRE/POST EVALUATION
• What is Institution-based rehabilitation?
• What is community-based rehabilitation?
• What are outreach programmes?
• List needed logistics for initiating community-based rehabilitation programmes
• What is development?

India has a population of 100 crore and more; it is estimated that little more than
population of Australia is added every year. Population increase is the bottleneck for
development in most developing countries.
42 Community Based Rehabilitation of Persons with Disabilities

Disability related issues take back seat often. Prospects of establishing Institutional base
for rehabilitation will not only be cost-intensive, but also impractical keeping in mind spread
of population across more than 6 lakh villages and more than 3000 towns and cities. It
becomes obvious and necessary to evolve a system of rehabilitation which is cost-effective,
appropriate and which will be accessible and affordable to people. While institutional bases
will be valuable as resource bases, there is need for a community-based rehabilitation focus
in each and every village and urban pocket. Should we employ rehab manpower in all
villages? or should we train local manpower—family and community workers in the process?
Latter appears more appropriate. Should we train personnel of the existing essential services
in the villages and slums—teachers, anganawadi workers, health workers, and panchayat
workers as facilitators? Should we focus and ensure responsibility for rehabilitation to
disabled persons themselves, their immediate kith and kin, and the family members? Should
we train community workers exclusively for rehabilitation?
In India, there are many attempts in this direction. Attempts and approaches have been
innovative and practical, sustainability of programmes have been a challenge.

Institution-based Rehabilitation
Homes for the disabled, special schools for visually impaired, special schools for children
with hearing impairment, special schools for children with mental retardation, cerebral palsy,
have been the usual pattern. Though residential schools are available, running these schools
from morning till evening is more common. Assessment, informal education, vocational
counselling and training, use of aids and appliances are common services offered. Often
these are run by NGO/private management and depend on external funding, more children
from middle and upper class are benefited and only a meager number of children have
access since number of schools are less and located only nearer to/in towns and cities. A
substantial number of these kinds of institutions are run with funding from state/central
government source and has been the approach by government for many years.
Positive points in this approach include—more focus for special children, opportunity
for individual planning and parents have time to attend to work. On the negative side,
cost-intensive nature and difficulty to establish special schools in villages, towns and cities—
number of institutions and rehabilitation manpower needed is enormous, parental
involvement will be less and sustainability of programmes becomes questionable on long
term, transportation of children from home to school and back will be a critical area.

Camp Approaches
Many non-governmental agencies and governments have tried organizing camps for
screening for surgery, assessment, distribution of aids and appliances, issue of disability
certificates, etc for children/adults with disabilities in many places and is a feature even
now. On the positive side we notice reach of more people, reach to remote areas where
rehabilitation services are not available; on the negative side we notice questionable follow-
up services. A few organizations have tried to evolve systems for systematic follow-up
and achieved success too. It may be worthwhile mentioning that large scale camps are
Concept, Principles, Components of Community-based Rehabilitation 43

organized by government of India with the help of community and NGOs through
ALIMCO—largest manufacturer of aids and appliances for persons with locomotor
disabilities in the country. Ashagram—a leading NGO in Bharwani in Madhya Pradesh has
conducted many such camps on a large scale in the state of Madhya Pradesh.

Outreach Programmes
Some NGOs in certain cities have tried to develop mechanisms to ensure rehabilitation
services in slums through periodic visits by specialists, social workers and rehabilitation
workers. Often, this has been the feature in many slum area programmes. Attempts have
been made to involve the families, disabled people, communities, local governments, special
schools, hospitals, etc.
Attempts have been made to organize parents of disabled children; adult disabled—
to stand for their rights. Approach of association of people with disabilities in Bangalore
is a notable successful attempt in this direction. Similar attempts have been noticed in Karkar
Dooma slums in New Delhi by Amarjyothi Charitable Trust and Baroda Citizen’s Council.
Action Aid India, a UK-based International NGO has supported these programmes.

Challenges
While attempts have been made to reach persons with disabilities through these approaches,
question is one of large population of India and need for scaling up operations on a large
scale. Second challenge is how to make it a priority issue as a community’s realization and
make it sustainable. How to go about in this direction?

Government Programmes
We see many attempts by governments to address the issue of disability. Government of
India supports more than 600 NGOs across the country for disability programmes every
year. Both government of India and state governments to support disabled persons with
aids and appliances, maintenance allowance, support disability programmes by NGOs, have
evolved schemes. Recently, special surveys have been conducted to identify persons with
disabilities in the states of Karnataka (1991-92) and Madhya Pradesh (1995). A special
question was included in census questionnaire of 2001.

Approaches seen in India


• Empowerment of persons with disability
• Empowerment of community
• Service approach
• Service plus empowerment approach
• Prevention of disabilities
• Trauma care and sports medicine
Notable attempts by Government of India to scale up operations as well as bring in
community involvement include:
44 Community Based Rehabilitation of Persons with Disabilities

• District rehabilitation centre scheme, grameena punarvasa yojana, and national


programme for rehabilitation of persons with disabilities. We see appointment/
redesignation of disability officers in each district in many states. Enactment of Disability
Act of 1995 based on UN standard rules.
• Establishment of National Institute of Mentally Handicapped, Secunderabad
• Establishment of National Institute of Visually Impaired, Dehradun
• National Institute of Orthopedically Handicapped, Calcutta
• NIRTAR, Bhubaneswar
• National Institute for Hearing Impaired, Mumbai
• All India Institute of Speech and Hearing, Mysore
• National Institute of Mental Health and Neurosciences, Bangalore
Community-based rehabilitation was mooted as part of primary health care approach
at Alma Ata in 1979. While it is still in the stage of evolution in many developing countries,
there is a need for auguring this process increasing the scale of operations. At this juncture
it is worthwhile considering certain definitions, principles and approaches of community
based rehabilitation.
ILO, WHO and UNESCO define community-based rehabilitation as—“Within
Community Development …….the utilization (in an integrated programme) of approaches
and techniques which relay on local communities as units of action and which attempt to
combine outside assistance with organized local self-determination and effort and which
correspondingly seek to simulate local initiative and leadership as the primary instrument
of change.

Another definition by ILO, WHO and UNESCO says:


Community-based rehabilitation is a strategy within community development for the
rehabilitation, equalization of opportunities and social integration of all people with
disabilities. Community-based rehabilitation is implemented through the combined efforts
of disabled people themselves, their families and communities and the appropriate health,
education and vocational services.
Community-based rehabilitation is simple—Initiating primary rehabilitation therapy/
measures. It is complex as it depends collaboration, coordination and cooperation. It needs
multi-sectoral and multi-disciplinary action. Decentralization of responsibility and resources
is the critical area and for this, service capacities of governments and NGOs need to
improve. There is need for improvement of skills and capacities for community involvement
and empowerment of community to ensure equal access—to achieve economic, political and
social goals. Disability is just not a medical condition. The life of disabled people is made
difficult not so much by their specific impairments, as by the way the society interprets
and reacts to their disability. Disability often segregates and isolates the persons from their
own community. Often they are not included as a part of mainstream life, and generally,
disabled persons do not enjoy equal rights as citizens of our country or have access to equal
opportunities like the others.
“Disabled persons can’t do this” or “won’t be able to do that” are phrases we all hear
frequently about persons with disabilities. Such negating attitudes, their own as well as
Concept, Principles, Components of Community Based Rehabilitation 45

of others, have resulted in pushing persons with disabilities in to the margins of society
and have denied them their rights.
Community-based rehabilitation focuses on the needs of disabled individuals as well
as the involvement and responsibilities of the family and of the community in which the
persons with disabilities are living. The goals of community-based rehabilitation can be
expressed as:
a. To enable persons with disabilities to participate as fully as he or she chooses in family
life and in other social activities.
b. It provides opportunities for persons with disabilities to learn and to develop their
abilities and skills to be able to participate and integrate fully in the society.
c. To raise awareness in the community/society to achieve a barrier free environment, to
enable the persons with disabilities to participate in all activities without discrimination.

Basic Principles of Community-based rehabilitation


Though there is a debate on what precisely constitutes community-based rehabilitation, it
is generally accepted that the following should be included in a programme that aims at
integration and rehabilitation of persons with disabilities in the community.
a. Shifting services from the institution to the homes of disabled people: It focuses on persons with
disability living with their family, integrating them in the activities of the community,
be it a village or in an urban area.
b. Community-based rehabilitation enables people with disability to live independently,
through training in activities of daily living skills (ADLS), education, skills development,
employment opportunities, accessibility and social interaction with other members of
the family and community.
c. Interaction with other members of the community, without being neglected or
discriminated.
d. Shifting the services from professionals to trained community or family members: The purpose
is to demystify that training and care for persons with disabilities can be done only
by professionals. Members of the family and others have to be trained in giving these
services, as often the professionals are unwilling to work in rural or other places where
rehabilitation services are not available.
e. Ensure that persons with disability have a say in planning and managing the programme: It should
be ensured that disabled people are regarded both as recipients of services as well as
contributors to managing the programme. To enable this to happen, disabled persons
should be involved in taking decisions for the programme. They have to be trained to
be able to play this role.
f. Community-based rehabilitation programme should be flexible so that they can operate at the local
level, using the locally available resource. A flexible, locally relevant programme will ensure
community involvement, as they will have the capacity to manage it on their own.
Agencies extending specialized services can play a supplementary role in service provision,
which is not available locally.
46 Community Based Rehabilitation of Persons with Disabilities

Starting a Community-based rehabilitation Programme


A community-based rehabilitation programme can include early identification and early
intervention of disabilities, education, training in skills development, vocational training
and employment opportunities, provision of aids and appliances, accessing the benefits and
schemes from the government, raising awareness on the rights and disability issues, barrier
free environment, non-discrimination, and any other activity that is relevant and necessary
in empowering and enabling the persons with disability to live independently.
In starting a community-based rehabilitation programme, the following should be
considered:
a. Collect the details of persons with disability in the area.
b. Do a general analysis of the community, including resources available to provide
necessary services. As far as possible, utilize or promote locally existing services and
facilities.
c. Bring disabled people together in a forum and give them an opportunity to express their
opinion and needs.
d. Get the support and assistance of professionals where needed, by identifying
organizations and institutions in the area providing services for disabled persons.
e. Involve disabled persons, their families and members of the community in all the
activities from the very beginning and at every stage, to build a genuine cooperation
rather than a relationship of dependency.
f. Transfer the skills of rehabilitation to the parents of children with disability, family
members, adult disabled and also to people such as anganwadi and village health
workers and others.
g. Ensure inclusion of disabled persons in the various government schemes.
h. Disseminate information on disability and the rights of persons with disabilities.
i. Give positive images of persons with disabilities, to bring positive attitudinal changes
about the abilities of persons with disabilities.
j. Help people with disabilities and their families to get the confidence to make necessary
decision for their future, and help them to become self-reliant, respected and active
members of the society.
The organizations working directly with the people with disabilities are addressing their
needs and problems and helping them to integrate in the mainstream of the society.
However, it is not the responsibility of these organizations alone. NGOs and social
organizations working in different fields, can do a lot to support one another for equal
rights for disabled people.
In this, action is required on the following aspects:
a. Changing peoples’ attitudes to disability and disabled people.
b. Building the confidence and self-esteem of disabled people.
c. Eliminating physical and functional barriers for equal participation of disabled people.
d. Raise awareness on the rights of persons with disabilities and bring them in a forum
to express their needs and for solidarity.
e. Advocate for the rights, equal opportunities and non-discrimination with policy makers
and bureaucrats.
Concept, Principles, Components of Community Based Rehabilitation 47

An Exercise
List the activities you identify as priority to work with persons with disabilities in your
area. Your strategy and broad plan of action should take into account,
a. The environment and physical conditions of the area;
b. Culture and traditional practices of the people;
c. The services and resources that are already available in your area;
d. The resources and capacity of your organization to implement the programme;
e. The support you require, besides finances, in implementing the activities.

Organisational Case Study I from Karnataka


Shree Ramana Maharishi Academy for the Blind (Regd.)

Sri Ramana Maharishi Academy for the Blind (SRMAB) was initially running a special school for visually
impaired from 1969 in Bangalore, India and Agro-based training centre for all category of people with
disabilities at Tirumurthy Rural Development Centre (TRDC), Jakkasandra, near Kanakapura in
Karnataka, India from 1985.
Later the Academy started its activities through community-based rehabilitation. In this endeavour
Sourabha was the first one.

Sourabha (Relief Approach/individual based) was started to function in Kanakapura taluk from 1990.
As the project and the approach were new it started as “Relief Approach/individual based”. In this
approach the project started to rehabilitate the people with disabilities at their doorstep. The rehabilitation
services were like providing aids and appliances, financial assistances for the economic empowerment,
therapeutical skills, non-formal education and other health aspects giving importance to prevention,
early identification and awareness.
The project covered a target area of 148 villages with 1800 people with disabilities as the target group.
The project span was 10 years, i.e. from 1990 to 2000.
Based on the mid-term evaluation, Sourabha adopted a new methodology for the future years, keeping
the results of mid-term evaluation then onwards Sourabha started organising Self Help Groups (SHGs)
at village level, Hobli Level Rehabilitation Council at Hobli level and at A Federation at Taluk level
and started providing more attention towards severe people with disabilities. Sourabha in its life span
has undergone the following roles.
1) Provider
2) Guider/supporter
3) Facilitator
Gramarakshe (Rural Development Approach)
Through the support of International Agriculture and Training Programme, UK the project started providing
the services to Farmers, Children and Women – it was a three dimensional approach on the concept
of agriculture and its allied field. In order to run the programme more effectively new groups were formed
viz., Credit Management Group. Later, the same was developed as a Cooperative Society at Kodihalli
Hobli. As if the programme was for rural farmers—the parent organisation was working for the welfare
of persons with disabilities (PWD) integrating them into the mainstream. The target area was 75 villages
of Kodihalli Hobli of Kanakapura taluk, which covered both rural farmers and people with disabilities.
RR/ADD/September 2003
48 Community Based Rehabilitation of Persons with Disabilities

Samanvaya (Development Approach)


This programme was initiated during 1997 with the partnership of CBR forum. Here the organisation
followed and adopted “Development Approach” in this approach, PWDs were integrated into
developmental issue. When the mind set of the society was linked with this philosophy, then only one
can bring PWDs in to mainstream of our society. In this programme, the organisation experimented
the concept at Kodihalli Hobli of Kanakapura Taluk. Before initiating Samanvaya the organisation was
running a rural development project viz., Gramarakshe through the support of IATP, UK. The base was
utilised to test integration of developmental concept with CBR. Formation of Self Help Groups (SHG),
training, financial linkages, resource tapping, networking with general poverty elevation and
development programmes of Government of Karnataka etc.
This approach gave a very good result. In this project the project personnel not only formed Self Help
Groups but also formed groups like women groups, PWDs group, children clubs, formers group, youth
groups, Hobli level rehabilitation committees were formed and even today an example of Cooperative
Society is existing in that project.

Samudaya (People Oriented Approach)


Later in 1997 the organisation started the new CBR project in Halagur Hobli of Malavalli taluk with
the partnership of AIFO, an Italian organisation. This project was an experiment of two approaches 1)
integrating leprosy with CBR and 2) directly starting the CBR project with the group concept (People
Oriented Approach)
As the partner agency was mainly working on the leprosy concept and they wanted to shift from leprosy
to all forms of disability and they were interested to know the result of integrating leprosy work into CBR.
As a result, the partner agency expanded the same module to entire Malavalli taluk during 2000. And
in 2002 the same module was extended to other taluks of Mandya District and 2 taluks of Bangalore
Rural District. The total coverage of the project is 5 taluks viz., Malavalli, Maddur, K R Pete, Ramanagara
and Chanapatana covering around 13,000 people with disabilities including persons affected with
leprosy.
Formation of groups of persons with disabilities as the earlier phase of activity and addressing the
issues is the main strategy in “people oriented approach” of the project.

Samyukta (Phased Approach)


This CBR project was started in the year 1999 with the association of CBM International. The target
area for this project was selected in Kanakapura Taluk. The Chikkamuduvadi Block was not covered
under Sourabha and Samanvaya the organisation took this area for its activities. In Samyukta
programmes are implemented in phases. Now the project is maintaining 75 villages as its target area.
The main approach in the project is formation of groups like Self Help Groups (SHGs) and Women’s
groups. The services are delivered through groups.

Sangama (Capacity Building and Strengthening of Groups)


Sangama is a confluence project of Sourabha, Gramarakshe and Samanvaya after the withdrawal of
the projects from the funding partners. The project was aimed at Capacity Building and Strengthening
of existing groups. The project is organising various training programmes, workshops and seminars.
The project has also sought the available schemes from the government to individuals and groups
to strengthen them.
Mr T V Sreenivasan
Founder President, Sri Ramana Maharishi Academy for the Blind
I Cross I Phase JP Nagar, Bangalore, Karnataka, India
E-mail: srmab@yahoo.com
Concept, Principles, Components of Community Based Rehabilitation 49

Organisational Case Study II from Kerala


Association for Welfare of the Handicapped (AWH) Calicut has the unique distinction of providing
comprehensive services to all types of people with disabilities viz. blind, deaf, mentally retarded, mentally
ill persons, leprosy cured and locomotor disabled including cerebral palsy.
With a modest beginning in 1975 as a registered organization, AWH has grown far and wide covering
5 districts of northern Kerala. The services include educational institution for the blind, deaf, deafblind, mentally
retarded, children with cerebral palsy and locomotor disabled. Starting from the early intervention unit where
children are brought before the age of one, educational programmes have come up to degree level. AWH
Special College, Kallai and AWH Engineering College, Calicut stands testimony to the long-term vision of
AWH. Printing Institute in Calicut gives 2 years training in printing subjects. Short-term and approved regular
recognized courses in computer technology helps deaf and locomotor disabled to get lucrative jobs. The
voice synthesizer unit in Kerala School for the Blind helps blind children in learning computer.
As part of human resources development, AWH has started various teacher training programmes like
DSE (MR), B.Ed (HI), B.Ed (MR) etc. AWH has other courses like BPT, B.Sc Speech Language and
hearing, MSW, etc. which will solve the man power shortage in disability intervention.
For the locomotor disabled, AWH has a prosthetic and orthotic center (limb fitting center) With
collaboration of MEND Trust, Newzealand, AWH makes user friendly mobility aids (Tricycles, Wheel
chairs and Walkers).

What is special about the ‘SESHY MODEL’ of CBR ?


Seshy developed as a nice blend of both CBR and IBR by adding the merits and avoiding the demerits
of both CBR and IBR. It started small rehabilitation centres in all the panchayats of the block to give
special education, parents training, counseling, vocational training, physiotherapy, language and speech
stimulation and other early intervention programmes. These centers are also used to give awareness
classes to disabled groups and other community groups. Every community-based rehabilitation centers
of the Seshy project have its own parent teachers groups and support groups of the community. The
centers and these groups literally made miracles in the areas like knowledge, attitude and practices
related to the welfare and empowerment of PWED in the district.

The impact of CBR;


a) It created great attitudinal change among the parents, family members and the community in general
about the disabled and disabilities.
b) It clearly convinced the significance and effectiveness of the early intervention and education.
c) The Community-based Rehabilitation centers and the groups related to these centers ensured active
involvement and effective participation of the PWD, their parents, family members and the community
in general in all the areas of our programmes like planning, implementation, monitoring and evaluation.
The wholehearted support of the community in terms of men, money, material and moral support
to these centers has been really commendable.
d) It acts as models for replication for many like minded agencies and motivated them to begin similar
programmes.
e) These centers provided quality services regularly ensuring cost-effectiveness and maximum coverage
and played the role of nuclei of all CBR activities in that area.
At present Seshy has 18 CBR centers covering 16 panchayats of Malappuram district giving regular
services to nearly 500 beneficiaries.
Contact Person : Dr. V. Kunh Ahamed Kutty, Hon. President
ASSOCIATION FOR WELFARE OF THE HANDICAPPED
P.B. No. 59, Pavamani Road, Calicut – 673 001, Kerala
Ph: 0091 – 495-2720601, 2720434, Fax : 0091-495-2720028, e-mail: awhclt@sancharnet.in.
50 Community Based Rehabilitation of Persons with Disabilities

Organisational Case Study III from Bangalore, Karnataka


Approach of Mithrajyothi, Bangalore, and Karnataka, India – an NGO working for Persons with Disabilities:
Mithrajyothi believes that all persons with disability have the potential to become independent and self
sufficient and given the right opportunity, to achieve their goals and play a useful role in the community.
Mithrajyothi assists people with disability to become independent by making them aware of their rights
and responsibilities providing them with an enabling atmosphere through networking with other
organizations and people, designing training programmes that teaches them coping skills, supplementing
educational needs, vocational training and job placement.

Ms. Madhu Singhal


Managing Trustee
Mithrajyothi
Bangalore, Karnataka, India
mjyothi@vsnl.com

Organisational Case Study IV from Andhra Pradesh


COMMUNITY BASED REHABILITATION
AND
INCLUSIVE EDUCATION
(Experiences of MORE an NGO)
INTRODUCTION
Movement for Rural Emancipation (MORE) is a voluntary non-governmental organization (NGO) based
in Madanapalle in Chittoor district of Andhra Pradesh. It took up work with disabilities 5 years ago helping
children and adults with different disabilities overcome their impairments while they continue to live
with their families within their community as opposed to institutionalising them. This approach is called
Community Based Rehabilitation (CBR).
One of the principles of CBR is to ensure that the community Impairment: Any loss or abnormality of
who benefits from such interventions gradually takes over psychological, physiological or anatomical
the responsibility of managing the rehabilitation programme. structure or function;
Those people who have disabilities and have been able
to overcome them are encouraged by MORE to become Disability: Any restriction or lack of ability
activists and help others in turn. MORE stresses upon the (resulting from an impairment) perform an
latent potentials of persons with disability by acknowledging activity in the manner or within the range
each one of them only to be a differently able person (DAP) considered normal for a human being.
rather than emphasizing upon certain incapacity. An Handicap: A disadvantage resulting from
individual’s abilities will find no bounds when they are an impairment or disability that limits or
recognized and given the right opportunities. Education prevents the fulfillment of a role that is
plays a key role in this process. normal for that individual.
Education is a fundamental right for all people, of all ages, throughout the world. There is a need for
making education more relevant and universally available keeping in mind the needs of persons with
different disabilities.
MORE recognized the learning needs of persons with disability and worked towards ensuring education
to every category of disabled persons as an integral part of the formal system. MORE worked closely
with about 100 primary schools in the project area keeping a special focus on Mental Retardation,
Cerebral Palsy, Speech & Hearing and Visual Disabilities. In order to include children with special needs
in the regular schools MORE arranged a series of training programmes for peer group (children) and
Contd...
Concept, Principles, Components of Community Based Rehabilitation 51
Contd...
support group (adult) members. As part of its Inclusive Educational interventions MORE assisted children
with communication and visual disabilities to learn Sign, Language and Braille Education respectively.
For this the project staff transferred skills to the concerned children and also engaged school teachers
and other community members in the process.
Inclusive Education (IE) not only provides quality education to all children but also changes discriminatory
attitudes within communities and helps develop an inclusive society. A child-centered pedagogy is
beneficial to all students and consequently to the society as a whole. Child-centered schools are moreover,
the training ground for a people-oriented society that respects both the differences and the dignity of
all human beings.

STRATEGIES ON IE
Children with special needs should be included in all the educational arrangements made by the state.
This idea has led to the concept of IE where the challenge is that of developing a child centered pedagogy,
for all children including those who have serious disadvantages.
To facilitate inclusive education MORE has been striving to achieve a clearly stated policy, understood
and accepted by the school system and the wider community. Such a policy should allow for curriculum
flexibility thereby reducing the pressure on teachers and pupils alike. At the primary school level the
community should be in a position to determine what children learn based on the needs and capabilities
of the given area. MORE has been encouraging the CBR Groups to debate on the minimum
competencies that their children should achieve at the primary school level. This discussion has thrown
up a lot of ideas on how make education more activity based and joyful.
MORE has been carrying out teacher orientation programmes so that they could pick up skills to deal
with children with special needs within the regular school system. In one of such programmes a teacher
said, “I always used to think that any disabled child must be put in a special school. But now I am
convinced that they need not go far away from their homes. They too can learn with other children.
After all they too are children!” The project has also developed teaching learning material, which are
being used both at the classroom and home. As a result of these measures the number of children
with disabilities enrolled at government schools has increased significantly. The following table gives
data pertaining the 100 primary schools within the project area:

Type of disability School going Out of school Total


Mental Retardation 62 66 128
Cerebral Palsy 26 36 62
Speech and Hearing 82 44 126
Visual Disabilities 35 27 62
Locomotor Disability 156 49 205
TOTAL 361 222 583
% 62 38 100

MORE pays special attention to facilitate girls with disabilities and children with severe or multiple
disabilities access education. They have the same rights as others in the community to achieve
independence as adults and should be educated to the best of their potential towards that end. In
exceptional cases where children are placed in special schools, their education need not be entirely
segregated. MORE has been working towards facilitating part-time attendance at regular schools.
MORE has been providing opportunities for children with special needs so that they can bring out their
creative talents. These talents have demonstrated to the larger community that persons with disability
too have rights. The project has promoted drama, art and sports events highlighting the need for barrier
Contd...
52 Community Based Rehabilitation of Persons with Disabilities

Contd...
free environment. The project hopes that these activities in the long run will add to the empowerment
process of persons with disabilities.

Equipping Parents
As part of building capacities of the most marginalized people MORE has been training parents of
disabled children on therapeutic and educational aspects. The project trained 310 parents during 2003
through disability specific workshops and imparted knowledge and skills relating to upbringing of their
children with disabilities.

Interface with regular schools


MORE advocates for Quality Education where all children learn together and the school responds to
diverse needs of the learners. An inclusive education system must respect different styles and rates
of learning. Over the past 5 years the project staff have worked closely with the Education Department
and facilitated more than 361 children with disabilities to get absorbed into the mainstream schools.
During 2003 another 18 children were added to the list. There are still about 125 educable children
who are out the school system. The project is trying to bridge the gap.

Peer and Support Group Training


In order to sustain the disabled children at schools the project trained a group of child volunteers who
provide peer support for the children with disabilities in terms of reaching school, classroom processes
and extra curricular activities. Similarly a group of adults’ volunteers were trained by the project so that
they could help the children with disabilities that have been put at school this year. This group consists
of elders in the neighbourhood, Disability Activists and Vidya Volunteers.

Special Skills
As part of inclusive education MORE assisted children with communication and visual disabilities to
learn Sign Language and Braille Education respectively. In order to make these special skills more
workable the project tried to popularise them within the community. MORE enhanced the learning
processes at schools through the provision of teaching materials and by encouraging co-curricular
activities. This facilitated the schools to become more inclusive. Simple material was used for this purpose
that relate shape and colour.

Creative Expression for DAP


Drama, sports and art events have been very popular events in the community. They provide an
opportunity for the DAP to showcase their talents, and to participate in community activities. MORE
enabled children with disabilities to express their creative talent during 2003.

Community Centers
As part of generating resources within the community MORE encouraged the CBR Groups to identify
suitable places for rehabilitation activities. During 2003 the CBR Core Groups were able to set up 6
community centers in nodal villages where DAP and other members were able to get together and
carry out common activities such as therapeutic exercises group meetings, health camps etc. Such
meetings encouraged community caring mechanism.

Cultural Teams
Human Resources are the best resources that are available in the community. MORE trained 3 groups
of DAP in different cultural activities like group songs, group dances and street plays. These groups
can give packages of cultural programmes and were closely associated with all group activities during
the year.
Concept, Principles, Components of Community Based Rehabilitation 53

WHY CBR?
MORE believes that CBR brings rehabilitation know-how to rural and slum communities thereby enabling
people to take responsibility for their own lives. It is implemented through combined efforts of disabled
people themselves, their families and communities. It is a serious effort towards de-institutionalizing,
de-professionalising, and de-mystifying the techniques of rehabilitation.
One of the key aspects of MORE’s work during 2003 was to align the CBR movement with that of Gram
Panchayats (local government bodies) and make it self-sustaining. Consequently the 44 CBR Groups
formed and strengthened by MORE during the past 4 years were re-aligned with that of 38 Gram
Panchayats in the project area. This implied some amount of re-deployment of staff and re-organization
of the structure.
The CBR Panchayats consists of 15 to 30 DAP depending on the size of the Gram Panchayat. The
members elect a President and 5 Disability Activists (one each for LD, MR, CP, SH and VD) for a two-
year term. The president and the Disability Activists form a core group at the CBR Panchayat level.
This Core Group appoints a CBR Worker (CBRW) in consultation with the project staff.
CBRW is a part-time paid worker who is constantly trained by the project so that he/ she is in a position
to provide therapeutic and educational inputs for DAP. MORE today has 38 committed CBRWs who
are increasingly becoming the agents of development apart from disability rehabilitation.
The Disability Activists elect their spokespersons that operate at the Mandal level. Each Mandal has
5 disability-specific spokespersons. These spokespersons in turn elect Disability Leaders to represent
DAP at the district level.

MORE adopted rights based approach for its CBR project during 2003 with a five-pronged strategy.

ADDRESSING IMMEDIATE NEEDS OF THE POOR AND MARGINALISED


Needs assessment is the key intervention in any CBR programme. MORE has been engaging
Specialists to carry out individual needs assessment of DAP during the past 4 years. However in 2003
the project’s emphasis was to involve the Disability Activists in carrying out the needs assessment. This
was keeping in mind the need for involving community in rehabilitation planning and implementation.
Each CBR Panchayat collectively identified the most vulnerable individuals/ families within their group,
after which the Activists assessed their needs, focusing on their therapeutic, social and economic needs.
Based on the needs assessment detailed individual plans were made for each DAP. These plans formed
the basis for the rehabilitation work during the year. 285 DAP were assessed during 2003 through
community participation.

Aids, Appliances and Devices


Provision of functional rehabilitation services is one of the essential components of any CBR programme.
MORE helped 200 DAP during the year 2003 get access to aids and appliances thereby reducing
disability, enhancing self-esteem, and preventing unnecessary further disability. The project ensured
that the skills and techniques of repairs and maintenance was transferred from the staff to the CBRWs,
Disability Activists, DAP themselves and their family members.
The Orthotic and Prosthetic (O and P) Unit of MORE has done an incredible job in popularising disability
related aids and appliances not only among the target group but also among the general public.

Referral Support
MORE facilitated the link between the CBR Panchayats and the host of referral institutions in the nearby
cities like Bangalore, Tirupathi, Vellore, and Puttaparthi, besides Madanapalle. The project arranged referral
support fund at the Panchayat level and facilitated the CBR Core Group (consisting of the President, the
Disability Activists and the CBRW) to identify the needy DAP for the medical visits. The project helped the
Contd...
54 Community Based Rehabilitation of Persons with Disabilities
Contd...
CBRWs and Disability Activists to contact the relevant institutions, fix appointments and escort the DAP. The
CBRWs and Activists also ensured that the follow-up measures recommended at these referral centers were
regularly adhered to. More than 40 DAP were benefited by this activity during 2003.

Surgery Support
Although free surgery is available at Government Hospitals, the cost of peripherals such as bandages,
medicines and the like have to be borne by the family. Since these costs are prohibitive for the poor
families, they require support. A Support Fund has been created by the project at the CBR Panchayats
in order to meet the expenses of surgery peripherals, cost of travel for surgery or referrals, etc. The
CBR Core Groups took the responsibility of deciding which family requires how much support. More
than 20 DAP were benefited from this activity.

Therapy Camps and Clinical Case Conferences


The project carried out 93 clinical case conferences across the project area during 2003 and facilitated
interventions for the most urgent/severe cases. These conferences were carried out in a manner that
was educational for the DAP family, community and the CBR Core Group. During the clinical case
conference, the entire CBR team, including the Disability Activists, the CBRWs, the Social Worker, the
Team Leader, and the Specialist sat together and carried out diagnosis and prognosis exercise. Hence,
the process enabled collective planning and implementation, with appropriate follow-up thereafter.

BUILDING ORGANISATIONS AND CAPACITIES OF THE MOST MARGINALIZED PEOPLE


Activist Training
CBR Panchayats are gradually emerging as DAP pressure groups in the project area. In order to make
them strong and broad based MORE has been promoting Disability Activists. The process of identifying
Disability Activists began in 2002 and subsequently during 2003 the emphasis was laid on training
them and building their capacities. Each CBR Panchayat has identified 5 Disability Activists — one
each for LD, MR, CP, VD and SH. Hence, the project works with 190 Activists. Series of training
programme were carried out by MORE during 2003 focusing on medical, social and political aspects
of disability. These training programmes were spread in 3 phases for each disability.

Equipping Parents
As part of building capacities of the most marginalized people MORE has been training parents of
disabled children on therapeutic and educational aspects. The project trained 310 parents during 2003
through disability specific workshops and imparted knowledge and skills relating to upbringing of their
children with disabilities.

Leadership Workshop and Training for Office Bearers


The Office Bearers of the CBR Panchayat consist of the CBRW and the President. They are the joint
holders of the CBR Bank Account and are responsible for all project inputs. MORE believes that these
office bearers need to understand the principles of CBR and act in a cohesive manner so that the
group capacities are enhanced. Hence, the project arranged special leadership workshops for them
during 2003. Seventy three persons participated in these workshops where exercises on group dynamics,
resource management practises and participatory appraisal techniques were familiarised.

Network
MORE wants to bring together on one platform different CBR Groups to give their voice a joint strength.
This is done at Mandal, District and the State levels. During 2003, the project was able to initiate action
on Mandal and the State level. With regard to Mandal CBR Forums Madanapalle, Vayalapadu and
Kurabalakota have been the opening initiatives of the project. Here the forums are gradually emerging
from the grassroots level and providing appropriate leadership. As far as the State level network is
concerned MORE forged alliances with different national organizations.
Concept, Principles, Components of Community Based Rehabilitation 55

Workshops with traditional birth attendants


In order to build capacities of CBR Panchayats in preventing occurrence of disabilities MORE arranged
workshops with traditional birth attendants. Sixty-two persons participated at these workshops. The
emphasis at these workshops was on early detection and intervention of different disabilities.

Workshops with Local Carpenters and Cobblers


With a view to take rehabilitation to the doorsteps of DAP the project provided training to 38 carpenters
and an equal number of cobblers. The training programme covered areas like fabricating and repairing
disability related devices (corner chairs, walkers, parallel bars, simple callipers, etc).

Peer and Support Group Training


In order to sustain the 18 children at the schools the project trained a group of 90 children who provide
peer support for the children with disabilities in terms of reaching school, classroom processes and
extra-curricular activities. Similarly a group of 76 adults were trained by the project so that they could
help the children with disabilities that have been put at school this year. This group consists of elders
in the neighbourhood, Disability Activists and Education Volunteers.

Special Skills
As part of inclusive education MORE assisted children with communication and visual disabilities to
learn Sign Language and Braille Education respectively. In order to make these special skills more
workable the project tried to popularise them within the community. MORE enhanced the learning
processes at schools through the provision of teaching materials and by encouraging co-curricular
activities. This facilitated the schools to become more inclusive. Simple material was used for this purpose
that relate shape and colour.

Creative Expression for DAP


Drama, sports and art events have been very popular events in the community. They provide an
opportunity for the DAP to showcase their talents, and to participate in community activities. MORE
enabled 173 children with disabilities to express their creative talent during 2003.
The above mentioned measures have gone a long way in building CBR organizations and the capacities
of DAP. The following are the expenditure details:

INFLUENCING POLICY IN FAVOR OF THE POOR AND MARGINALISED PEOPLE


Apart from DAP themselves, there are many change agents who are crucial players the disability
rehabilitation scenario. They include the state, national and international governments, socio-political
formations, NGOs, academic/ researchers, the media, business, trade union and increasingly the general
public. In addition to its micro project action MORE would like to interact with these change agents
with a view to bring about equalization of opportunities for DAP and their social integration. The need
for influencing change agents is primarily to organise a lobby in favour of DAP.
In order to raise public awareness of the presence, rights and needs of DAP the project carried out
rallies on the occasion of World Disabled Day (3rd December). More than 650 DAP participated in
three rallies conducted during 2003. Of these two were Mandal level rallies while one was the project
level rally. These rallies had the specific objective of impressing up the government to implement of
PWD Act, advocate for a barrier-free access to schools and other public buildings.

PROMOTING GENDER EQUITY


In order to promote gender equity MORE worked closely with groups formed for the Development of
Women and Children in Rural Areas (DWACRA). By inviting 52 DWACRA leaders for a workshop the
project was able to establish rapport with them. This enabled the CBR Panchayats to highlight gender
issues at community level.
56 Community Based Rehabilitation of Persons with Disabilities

Within the CBR Panchayats MORE attempted to bring about gender equity through orientation of office
bearers. This ensured that the transactions, benefits and control mechanisms at the CBR Panchayat
level were gender sensitive. Women members are beginning to assert themselves in protecting their
rights.

RESOURCE GENERATION
As part of generating resources within the community MORE encouraged the CBR Panchayats to identify
suitable places for rehabilitation activities. During 2003 the CBR Core Groups were able to set up 6
community centers in nodal villages where DAP and other members were able to get together and
carry out common activities such as therapeutic exercises group meetings, health camps etc. Such
meetings encouraged community caring mechanism.

Disability Certification
Certification by the government authorities is the first step for any rehabilitation service from the State.
It is a matter of right for any DAP to be certified and this needs to be carried out at the closest point
possible. MORE has facilitated 178 new DAP to be certified during 2003. Disability certification is a
continuous process at the project. Besides MORE has assisted the district administration in conducting
5 Certification Camps outside the project area.

Collaboration with Health Workers


Health Workers are a resource to the community so long as their services are properly used. MORE
encouraged the CBR Panchayats to utilise their services by way of organising workshops with them.

Collaboration with masons


Masons play the key role in the built environment. In 2003 MORE conducted a workshop for 31 masons
in order to familiarise them with barrier-free environment in the buildings they construct. Tips relating
to all disabilities were given to them.

CONCLUSION
Thus, MORE is following CBR methods in order to help DAP overcome their impairments while they
continue to live with their families within their community. Their abilities will find no bounds when they
are recognized and given the right opportunities. Education is a fundamental requirement in this process
and therefore there is a great need for making it more relevant and universally available. Inclusive
Education (IE) is very integral to any CBR programme. A child-centered pedagogy is beneficial to all
students and consequently to the society as a whole. Child-centered schools are moreover, the training
ground for a people-oriented society that respects both the differences and the dignity of all human
beings.

Aluganti Prasad, Director, MORE, Madanapalle, Andhrapradesh


Email : more@nettlinx.com

Organisational Case Study V from AIFO


AIFO
An international agency headquartered in Bologna, Italy, Associazione Italiana Amici di Raoul FOllereau
(AIFO)‘ collaborates its activities with the United Nations and is recognised as an official collaborating
organisation of the World Health Organisation.
It is recognised by the European Union and by the Italian Foreign Ministry for Projects of Development
Co-operation.
AIFO is a founder member of International Anti-Leprosy federation (ILEP), International Disability and
Development Consortium (IDDC) and Circle of Solidarity Follereau-Damien (CSFD).
Contd...
Concept, Principles, Components of Community Based Rehabilitation 57

Contd...
With Leprosy work as its focus, AIFO provides support to projects in developing countries, without any
discrimination on the basis of colour, race, religion, gender etc. It also supports rehabilitation of persons
with disabilities and programmes for vulnerable children with a community-based approach.
AIFO began its work in India in the early 1960s by supporting activities carried out by NGOs and also
supports National Leprosy Eradication Programme (NLEP) District Technical Support Team (DTST) in
24 districts in various states.
Working with over 40 NGOs spread across the length and the breadth of the country, AIFO which made
considerable progress in work of leprosy eradication has taken its activities one step further by making
community-based rehabilitation an integral part of all its activities.
Founded on the spirit of love for the destitute which found full expression in a great French social reformer
Raoul Follereau, AIFO has successfully embraced the concept of CBR which promotes the overall
development of an individual without uprooting the person from the community.
AIFOs reach has extended to remote villages of Assam which do not even have proper access roads
and also to interior villages in the dry lands of Bidar, a backward district of Karnataka.
Economic and social rehabilitation form an integral part of CBR work at AIFO. Education and health
issues of the community are also given equal importance. Facilitating income generation, job placements,
career guidance, establishing savings groups are some of the tried and tested methods of CBR practised
by AIFO.
Perhaps the most essential part of AIFOs programmes includes intensive training in important issues
relating to legislations, advocacy, information about disabilities, formation of Self Help Groups etc.
The result is evident in that, several Disabled Persons Organizations are not only empowered to take
control of their lives, but are now ready to rehabilitate their entire community. This is a reflection of
the meaning of complete rehabilitation and inclusion as per AIFOs experience in the field.

ASSIGNMENT FOR STUDENTS


1. Identify needs of persons with locomotor disability, visual impairment, mental
retardation, mental illness, cerebral palsy, communication disabilities, chronic illness, and
multiple disabilities.
2. Identify needed local resource/external resource for initiating Community-based
rehabilitation.
3. Do a systems analysis of the Community-based rehabilitation programme visited.

BIBLIOGRAPHY
1. ILO WHO UNESCO (1994) “Joint Position Paper” Community Based Rehabilitation Contributions made by
various projects within India and abroad for BOX items.
2. Rajendra KR and Pruthvish S (1997) Community Based Rehabilitation, Paper presented in workshop on
“Developing Indicators for Monitoring and Evaluation of CBR” - workshop facilitated by ActionAid India
1997.
3. Ramachandran, ADD India (2004) Community Based Rehabilitation.
Planning and
Implementation of
Community-based
7 Rehabilitation
LEARNING OBJECTIVES
At the end of the capsule, the participants must be able to participate in a planning process
of Community-based rehabilitation and contribute technical expertise. The participants must
be able to develop a mind-set towards demystification of technical aspects.

OUTLINE OF CONTENT
• Three Approaches for Public Health
• Knowledge, Attitude and Practices
• Skills, skill transfer
• Demystification attempts
• Appropriate Technology in Community-based rehabilitation
• Training of family members
• Training of volunteers
• Training of community members
• Planning Community-based rehabilitation in rural areas
• Planning Community-based rehabilitation in urban settings
• Planning Community-based rehabilitation in tribal settings
• Initiating Community-based rehabilitation activities
• Resource mobilization

SUGGESTED METHODOLOGY
Students are posted to a Community-based rehabilitation project/DRC (District
Rehabilitation Centre) scheme for one week; they participate in all activities of the project—
planning, monitoring, implementation; work with grassroot level workers; and prepare a
report.
Students choose a research question in Community-based rehabilitation and address it—
over period of month; under the guidance and supervision of a teacher.
Planning and Implementation of Community-based Rehabilitation 59

PRE/POST EVALUATION
• What is demystification?
• What is appropriate technology?
• List steps in planning Community-based rehabilitation

Three Approaches for Public Health


Disability, disabled people and their issues have both health and social implications.
Experience has shown that much can be gained by attitudinal change alone. Attitude of
disabled person to himself/herself, towards his family members and people in the
neighbourhood and place of work/education makes a lot of difference. More importantly,
attitude of family members and community members towards disabled person makes
difference to quality of persons with disability. By attitudinal change alone, increase in self-
confidence of persons with disability and proper guidance will help himself/herself seek
all necessary access to independence, education, training, employment and social integration.
There are three approaches to public health.
• Educational approach,
• Service approach and
• Legislative approach.
Educational approach aims at mere education of disabled person, his family members, and
community and help him gain more confidence and have access to information and
opportunities. This is like teaching him/her or his/her family how to fish. Probably this
makes lot of difference to people with disabilities. It may take long time for educational
approach to bring impact, but one needs to go beyond education to counselling to ensure
that sustenance of educational input occurs and empowerment occurs.
Service approach aims a provision of services like assessment, aids and appliances, medical
and surgical treatment, helping to fill up forms to seek government schemes like bus pass,
scholarship, identification card, support for employment, etc. This is like giving him a fish
every day.
Legislative approach brings order to governmental effort. Legislation ensures that policy
implications exist, budget allocations are possible and government personnel and machinery
take direct role in rehabilitation. UN standard rules, which formed the basis of disability
legislations across the world, are a best example in this direction. Mr Bing Linquist the
UN rapporteur was the architect of UN standard rules. In India, the Disability Act of 1995
is the result of this UN standard rules and is a good piece of welfare legislation. We will
study the excerpts from UN standard rules and Disability Act of 1995 in later chapters.
Other example of useful Legislation in India is the National Trust Act, which is useful for
persons with mental retardation, autism and severely disabled persons. A limitation of
legislative approach is that large machinery is required for implementation.
Educational, service and legislative approaches together have synergistic impact on
disabled persons and community.
60 Community Based Rehabilitation of Persons with Disabilities

Knowledge, Attitude and Practices


Sociologists have observed that even if people have knowledge, attitude and practice may
be contrary. This applies to any area and disability rehabilitation is no exception to this.
It is important that levels of knowledge, attitude and practices of persons with disability,
family members and community are studied before initiating community-based rehabilitation
work, repeat studies are made from time to time to monitor and study the impact of
interventions. University of Allahabad has developed a useful method called DABB
instrument, which will help in attitude measurement.
Focus group discussions, village studies, direct interviews will help us study change in
attitude. There are methods of qualitative nature, which can objectively measure changes
in attitude. One way to do this will be to design questionnaires to measure levels of attitude
like:
Satisfaction with services:
Strongly agree /agree to a large extent/agree/do not agree

Skills, Skill Transfer


India has a population of 100 crore. More than 75 percent live in 6 lakh villages spread
across 33 states and 7 Union territories. Twenty-five percent of people live in 3000 towns
and cities. Government is a major player in rehabilitation. NGO sector has a large
contribution for rehabilitation. Keeping this in mind if we analyze the manpower situation,
it is meager. Not many physiotherapists, speech therapists, occupational therapists, mobility
trainers, special teachers for different disabilities are in position. Institutions training
rehabilitation manpower are too less.
Following institutions are important from the point of view of training manpower in
rehabilitation in our country:

Government Sector
• National institute of mentally handicapped, Secunderabad
• National institute of hearing handicapped, Mumbai
• National institute of visually handicapped, Dehradun
• National institute of orthopaedically handicapped, Calcutta
• National institute of rehabilitation research and training, Cuttack
• All India institute of speech and hearing, Mysore
• National institute of mental health and neurosciences, Bangalore
• Universities across the country, for training of physiotherapy

NGO Sector
• Sri Ramana Maharishi academy for the blind, Bangalore
• Mobility India, Bangalore
• Association of people with disabilities, Bangalore
Planning and Implementation of Community-based Rehabilitation 61

• Spastic societies at Bangalore, Mumbai, Calcutta


• Madhuram Narayan centre, Chennai
• Sweekar, Hyderabad
• Special schools across the country

Others
With more than 45 million disabled people in India, access and opportunities being very
limited added with problems of illiteracy and ignorance, minimal rehabilitation manpower
available makes therapeutic interventions reach only a few. In this context it becomes
essential to train local community people and family members and person with disability
themselves to help themselves. Here, skill transfer becomes important.

Demystification Attempts
There are attempts by NGOs like Sri Ramana Maharishi academy for the blind in Bangalore
and rehabilitation council of India set up by Government of India to train health, education
and development workers, community and family members in skills required for
rehabilitation.
Experience of ActionAid India in more than 20 community-based rehabilitation projects
it initiated and supported with technical and managerial input depended on local volunteers
with pre-university qualification as change agents, who in turn trained family members;
indicates that demystification is possible.

Following examples indicate possibilities and necessity of demystification:


• Training of mothers, family members, principal care givers in activities of daily living
skills, follow-up physiotherapy, speech therapy, etc
• Training of physio-aids in physiotherapy
• Training of cobblers/carpenters in repair of crutches, wheel chairs, other equipment
• Training of electricians in repair of hearing aids.

Following are Useful Resource for this Demystification


Training of people with disabilities in the community—package developed by WHO

District Rehabilitation Scheme, GOI


a. Village Rehabilitation Worker
b. Multipurpose Rehabilitation Workers manual
Twenty community-based rehabilitation projects supported by ActionAid India across
the country, community-based rehabilitation projects supported by Christofel Blinden
mission, ADD India, outreach programmes of spastic society of Karnataka and association
of people with disabilities in Bangalore are worth visiting to have first hand knowledge
regarding possibilities of demystification.
62 Community Based Rehabilitation of Persons with Disabilities

Appropriate Technology in Community-based Rehabilitation


• Can we develop a walker with bamboo sticks in front of our village home?
• Can we use ordinary sticks made of cane/bamboo to help people with disabilities?
• Can we make wooden crutches in villages?
• Can we repair ortho devices in villages?
Will such attempts reduce dependence on doctors, specialist doctors, and
physiotherapists? A look at disabled village children by Davis Werner will help us know
about appropriate technology and determine how it can be adopted in our settings. A
knowledge of project Projimo in Mexico or any community-based rehabilitation project
mentioned above will help us understand appropriate technology better. A visit to any
community-based rehabilitation project nearby will be worthwhile.

Training of Family Members,Volunteers and Community Members


Training is an important area in community-based rehabilitation. Number institutions
focusing on community-based rehabilitation training are limited in developing countries.
India is no exception to this. Rehabilitation manpower is so less and opportunities for its
increase being too limited in the near future, there is need to consider every person with
disability, their family members and community to act as rehabilitation personnel. There
is need for training all in rehabilitation.

What should be the content and what should be the methodology of these training
endeavors?

Training of Family Members


Content
• Accepting disability of the person
• Needed medical/surgical intervention—how and where to seek
• Activities of daily living skills
• Follow-up therapy required
• Education possible
• Employment possible for the person with disability and how to facilitate the same.
Methodology
• In-house training by the community-based rehabilitation worker/health worker/doctor/
therapist
• Learning by doing

Training of Volunteers/Community-based Rehabilitation Workers


Content
• How to identify disabled persons?
• How to seek professional assessment?
• How to do needs assessment?
Planning and Implementation of Community-based Rehabilitation 63

• Types and causes of disabilities


• Government schemes
• Activities of daily living skills
• Physiotherapy skills
• Speech therapy skills
• Counselling skills
• Record keeping skills
• Communication skills.
Methodology
Formal training for 4 to 6 months in a community-based rehabilitation project/institution-
based rehabilitation project/special school continuously/break ups.

Training of Community Members


Content
• Prevention of disabilities
• Accepting disabled people
• Disability—causes, types
• Govt schemes
• How to help disabled people to be independent
• What is community-based rehabilitation?
Method
Awareness programmes from time to time in the community/communities through
discussions, skits, announcements, and workshops.
Planning community-based rehabilitation in rural areas planning community-based
rehabilitation in urban settings, planning community-based rehabilitation in tribal settings.
Community-based rehabilitation planning needs to be tailor-made to geographical areas,
cultural contexts, literacy of the people and type of disabilities found, and employment
pattern as well as resources available. One needs to look at distances, one needs to travel,
as rehabilitation is cost-intensive and manpower-intensive too.
More than 70 percent of our population lives in rural areas, 5 to 8 percent in urban tribal
areas and the rest in urban areas.
Out of 25 percent living in urban areas, almost one-third live in slums and migration
is too frequent and population may not be stable. In tribal areas, hilly terrain, less roads
and communication makes travel difficult and reaching professional services also difficult.
There is need to reach rehabilitation services for all at a cost it is affordable, using locally
available resources by available manpower with limited professional input. It should be
quality input and not cheap and not of lesser quality/compromise in quality. The
rehabilitation effort needs to be community-based and nothing should be done without
involving disabled people. In the planning process, implementation process and evaluation.
Following is an attempt towards putting our experiences towards arriving at an acceptable
and practical planning process.
64 Community Based Rehabilitation of Persons with Disabilities

Initiating CBR Activities


Steps involved in initiating community-based rehabilitation may be different in different
communities but overall—it may be useful to consider following steps:

Step I: Understanding the Communities


Best way to plan community-based rehabilitation is to meet a group of disabled people,
find out their quality of life, problems and address them. This is the best way to initiate
community-based rehabilitation.
One may find it useful to consult the previous census book of the respective revenue
district/gazetteer of the district/survey report of disabled persons/records of anganawadi
workers/records of NGO and rehabilitation workers operating in the area useful to know
the number of people villagewise/tribewise/slumwise.
One may find it useful to talk to primary school teacher, anganawadi worker, health
worker, panchayat secretary to find out how many disabled people are there in the village/
slum/tribal area and what government resources are available/utilized.
Meeting district disability officer, social welfare officer, child development project officer,
directorate of disabilities and commissionarate of disabilities will help us know available
government schemes, number of NGOs working in the area and nature of their work.
It is useful to visit couple of villages/slums/tribes and find out situation of disabled
people by meeting formal and informal leaders including women’s groups and youth groups;
and disabled people themselves in the area. It is useful to meet groups of disabled people
if they are already organized in the area.
Conducting formal door-to-door survey will help us identify disabled people, make
needs assessment. Surveys are always expensive and one may do it if they are sure to work
in the area. Surveys always raise hopes and aspirations among people and hence it is useful
to plan only after resources are determined to work with disabled people. It is useful to
start working, helping people and once confidence is gained in the community one may
resort to door-to-door survey.

Step II: Resource Identification and Mobilization


Resource mapping is important to initiate CBR work. It is useful to find out following
information:
• No. of primary schools/no. of secondary schools
• No and type of vocational training schools in the proximity
• No. of special schools for children with mental retardation, cerebral palsy, visual
disabilities, locomotor problems in the area
• No. of primary health centers, subcentres, community health centers, district hospital,
private hospitals, limb fitting centers
• Available support nearest to the area for professional physiotherapists, audiologists,
occupational therapists, speech therapists, orthotic and prosthetic technicians
• Nearest point for surgery/medical treatment
Planning and Implementation of Community-based Rehabilitation 65

• Details of religious leaders, influential formal (panchayat) and informal leaders,


anganawadi workers, health workers, teachers
• Details of education officer, child development project officer, district disability officer,
deputy director of women and child welfare, district officer for employment and labor,
district surgeon, district health and family welfare officer
Map of the area
• Details of occupations, sub-occupations, potentials for employment for disabled persons,
industrial training centres, artisan training centers in the area
• Details of community-based groups working for self-help/education/literacy/health/
family planning/water and sanitation/human rights, etc
• Details of corporate industries/philanthropic people/organizations in the area.
• Formal meetings with district/taluk/village level government and NGO functionaries
and communities will be very valuable in getting this information. Later stages, one
may consider doing PRA exercises useful.

Step III: Write a Plan/Proposal


It is useful to develop a plan and proposal. The proposal may be developed in a series
of meetings with formal and informal leaders, health workers, anganawadi workers, school
teachers, panchayat members, local government and NGO officials. It is essential that we
involve persons with disability in the development of proposal. The proposal may reflect:
Background, rationale and situation analysis
Why the effort is proposed? What is the preset scene in the area? Who are the major players?
What are the available resources? What is the magnitude of the problem? Problem definition;
your vision, mission and goals
Objectives of the endeavour
1. Approach and methodology
a. How it is planned for implementation? Pre- and post-evaluation, time frame, whether
health workes/anganawadi workers/teachers/panchayat members/formal and
informal leaders will be involved and to what extent? Any additional resource of
manpower will be appointed? How needs assessment is made? How professional
assessments are made? How medical and surgical needs are met? How aids and
appliances are accessed? How the repairs of aids and appliances are made? How
counselling is planned? How government resources like scholarship, bus pass, PHP
(Physical Handicapped Pension) is planned? How vocational training is planned? How
orientation and training of all govt/community people planned?
b. How vocational needs are met? Details of special schools for different disabilities
and how their resource utilized? What are the available avenues for vocational
training/employment/income generation planned?
c. How parents/family members of persons with disability are approachd, counselled,
trained, organized?
d. How aspects of Disability Act of 1995 and available resources of Government
accessed?
66 Community Based Rehabilitation of Persons with Disabilities

2. Organisational structure
a. Risk factors anticipated
b. Expected outcomes what may be a budget estimate for 1-year/3-years/5-years?
c. How monitoring is made/How evaluation is made?
d. What and how records will be kept?
e. Acknowledgement of people who helped in the development of proposal.

Step IV: Start Helping People Simultaneously


• One can start with holding awareness programme/counselling/assessment camps/
workshops on disabled people/helping with medical and surgical treatment/getting
scholarships/bus pass/PHP, etc.
• By doing detailed survey we will be raising aspirations of people. But it is always useful
to postpone this till assured support and commitment is sought to take up the work on
a large scale.

Step V: Get Support, Mobilize Resource


• One may like to broach the topic with panchayat members, education officer, primary
health center staff, local community groups, philanthropists, management of your institution
as to how you can link with them? How much time/aspect they like to take responsibility?
• Approaching directorate of disabled welfare at state and central level, organizations
like ActionAid India, ADD India, OXFAM, CBM international, Leonard Cheshire
international, CAPART, WHO, UNDP, UNICEF (specially for early intervention) may be
useful.

Step VI: Start Systematic Work once Resource Support is Assured. Till then Help
People Ad hoc
• Monitoring and recording systems
• Recording systems in community-based rehabilitation can be classified thus
• Records for individual persons with disability
It may be a file containing detailed history, preliminary needs assessment, goals for
rehabilitation arrived at in consultation with disabled person, family member and
professional by the grassroots staff.
It may have what is attended to a every stage—including counselling, assessment, aids
and appliances, bus pass, scholarship, vocational training, employment, awareness, exposure
visit, aspirations of disabled people and their families. This record is always with grassroots
staff.

Records at Village, Group of Villages (Hobli), Records for Entire Area—


PHC Area/Field Practice Area
This may include no. of disabled persons, type of disability, there needs, how much of
their needs addressed during the month, plan for next month.
Planning and Implementation of Community-based Rehabilitation 67

• No. of disabled people of different disabilities


• No. of needing assessment/had assessment
• No. of needing aids/appliances/no. of persons who have already received?
• No. of needing physiotherapy/speech therapy/mobility training/no. of persons whose
needs are met
• No. of needing bus pass/no. of persons needing already met
• No. of needing scholarship/no. of persons needing already met
• No of needing vocational training/no. of persons whose need already met
• No. of needing credit for self-employment/no. of persons needing already met
• No. of needing counselling/no. of persons needing already met
• No. of awareness programmes held/attendance/usefulness
• Sangha formed/in the process of formation
• No. of meetings held with Sangha of disabled persons

Minutes of Meetings Held


It is useful to keep recordings of staff meetings/meetings with primary health care staff/
community based groups/parents/groups of disabled persons.

Monthly/Quarterly Reports
This is consolidated from village/slumwise reports every month; analysis made in monthly
meetings and presented to advisory committee.
In addition it may include report of important events during the period, SWOT analysis
of efforts, plan for next three months.

Field Visit Reports


It is useful to keep records of supervisory visits, and staff is encouraged to keep dairies
of their visit.

Special Camp Reports


Special events like assessment camps, awareness camps are made and documented for future
and SOS reference.
It is essential that recording, monitoring systems be developed in each project by their
grassroots staff and supervisors. The systems need to be tailor-made for each setting.

Eswari: A Case Study

I am M Eswari born to Sri .M. Chandra and Smt M. Munilakshmi at Madanapalli town. I am 20 years
old and I have an elder sister and elder brother. When I was 3 years old I suffered from high fever
and ultimately got polio which resulted paralyzing of both legs disabled me, not to walk my nearest
relatives and parents moved me from hospital and trained their level best using all types of medicines
including visiting witchcraft doctors. Ultimately I was put in the hostel at Arogyavaram, which is run
by Christian Missionary (Bethesda polio home) 6 km away from Madanapalli town. Maids and teachers
have looked me after very well in the polio home. Since I was the youngest, hostel warden has created
Contd...
68 Community Based Rehabilitation of Persons with Disabilities
Contd...
lot of self-confidence in me. I have understood the limitations of life with disability and learnt quite a
lot from my friends who are also sailing in the same boat. I was always first in singing as well as in
sports. Some how I did not concentrate much on studies, hence I failed in 10th class. But hostel warden
as encouraged me to undergo training in tailoring work later; I was asked to go home with Tailoring
Machine. It was a memorable stay for about 13 years at Bethesda Polio Home, which has molded my
life with full confidence lead.
After my arrival at home made me to think of life in a different fashion. On one side, parents were heavily
burdened with financial problems specially my married elder sister with 2 children. Her husband left
leaving her as well as the children as parents and elder brother whose income is not beyond Rs.2500/-
per month. Since we don’t have house, major income is spent on rent, electricity, or bills, along with
school fees. On the other hand, the expenditure on kitchen also high and the situation is of hand to
mouth existence. My confidence and will power made me to take a bold step to help my family by
doing whatever work is possible. Even I worked hard in odd jobs like packing of soaps and cleaning
powders, manufacturing of candlesticks and even working as a part time keeper in public telephone
booth. I felt little bit proud since I am no more burden to them as well as helping them to add to the
income for the family. At this stage I was picked up by a Social worker of MORE who sent me for
‘VIKALANG BANDHU’ Training for a period of 3 months at Thirupati organized by National Institute of
Mentally Handicapped (NIMH). This training gives me lot of insight into the problems of Loco motor
Disability — especially for girls like me to live in the society. I have also understood the various types
of disabilities and solutions to live with disability are a great honor. MORE has molded my life after
the training and I was given the task to work as a representative on locomotor disability to participate
for the welfare of the disabled. MORE has exposed me in to the cultural activities and I was deputed
to Hyderabad. I could sing songs on disability and I felt very happy when my songs were recorded
and the cassette was released with my own hands. There is another memorable event, which has
happened at Hyderabad where I was well treated in Asian Social Fourm (ASF). In the forum I had
a chance to act in a sensational drama where I played the role of representative for locomotor disability.
I shared these memories with friends, relatives and family members who encouraged me to do more
social work for the disabled persons. Later, I have been deputed by MORE to participate in the World
Social Forum (WSF) held at Mumbai along with other disabled persons representing from my area.
This participation has enhanced by knowledge on the problems of disabled, human rights, violation
and social justice. This understanding, especially the interaction with the other disabled persons coming
from other countries has given me the opportunity to learn as the subject with great insight. Today, I
feel confident about my rights and I like to fight for the cause of other disabled suffering at all levels.
Now I feel very strong to bring change in the attitudes of the disabled persons if the chances are provided
with encouragement and not with sympathy.
by
Eswari

WHY SHOULDN’T I MARRY?


My name is Chalapathy. I am 32 years old and live in a small town called Vayalpadu. My father’s name
is Venkataramana and my mother’s name is Sarojamma. I have a younger brother who is married and
has two children.
I was attacked by polio when I was two years old. One of my legs and hands went crippled. My life
was miserable as my parents took me to different hospitals with variety of treatments. All these treatments
were in vain. Even I had a surgery at Hyderabad, which proved futile due to lack of post-surgical care
and proper physiotherapy. At last my parents put me at a special hostel in Hyderabad and got rid of
me. I stayed there for 10 years and returned home with neither proper education nor physical strength.
At the hostel I could study only up to 9th class. I was not given any occupational therapy so that I
could use my limbs effectively.
Contd...
Planning and Implementation of Community-based Rehabilitation 69
Contd...
As I had just returned from the hostel in Hyderabad in 1999 I met the Social Worker of MORE. She
persuaded me to become a member of the Community-based Rehabilitation (CBR) Group. At the CBR
Group I availed of a financial assistance to the tune of Rs. 900/- to purchase a sheep. I was happy
to look after the sheep with a lot of care. But unfortunately the sheep met with an accident and died.
This made me to mentally disturb but the CBR worker and the social worker of MORE gave lot of
confidence and guidance in getting the insurance money. This incident changed my course of life and
I became confident to fight against the odds with double vigor. I added some more money for the
insurance money and purchased a buffalo.
My desire to become self-reliant economically motivated my parents and brother to help me. They started
assisting me to look after the buffalo. Fortunately the buffalo gave birth to a calf and I started getting
income by selling the milk. There was no bound for my joy as became partner in the family income.
This enhanced my confidence as well as social status in my neighborhood that I am no way less than
the able bodied people.
By looking at the financial leadership in me MORE recommended my case for financial assistance
to set up a petty shop from a local Bank. The enterprise was sanctioned to start the shop to the tune
of Rs. 25000/- as a capital. I made a mistake by giving more loans to the customers since my business
was in the known locality with known persons. Then I switched over to renting out cycles. I purchased
5 cycles. Now with lot of business experience and knowledge I am quite independent economically
and now the family is depending on me. This is a great achievement for a person like me that disability
is no longer a handicap. Now I fight for the right of other persons with disability (PWD). I want to empower
all PWD with facilities and knowledge.
I have been constantly asked by my parents and relatives to marry. But I don’t have answer since I
have already decided to work for the disabled with the kind of mission. Only time will tell when I will
get married and with whom.

Sivakumar can walk to his school now!


(By Sreedher—Social Worker)
Sivakumar (14) lives in a village called Kothapeta. His father Chandraiah (40) and Mother Baghyamma
(35) work in a Spinning Mill near the village.
Sivakumar got fever when he was two years old. Before the parents could realize and take any remedial
action it turned out to be polio-fever leaving Sivakumar’s right leg paralyzed. The parents went into
a shock having come to know this. Before Bhagyamma could recover from the shock Chandriah decided
to marry again. He married Baghyamma’s own sister Lakshamamma.
Lakshamma (30) and Chandriah soon got two sons—Bhaskar (10) and Janardhan (6). The family lives
together. Chandriah and Bhagyamma’s earnings in the Mill barely make both ends of the family meet
while Lakshmamma takes care of the household chores. The family belongs to Vodde community, which
is one of the backward castes.
When MORE helped formation of CBR Group in Kothapeta in 1999 Baghyamma became a member.
She attended the meetings regularly and got to meet parents of other disabled children. In one of the
meetings the CBR Worker suggested that Sivakumar undergoes a surgery. The members discussed
about the need for Sivakumar’s surgery. Sivakumar had developed contracture because he was not
moving his paralyzed leg. There was need to release contracture by conducting a surgery.
Both Sivakumar and Baghyamma were afraid of the surgery. Father Chandraiah was not bothered about
the consequences. At this stage the CBR Worker, Lakshmidevi intervened. Lakshmidevi herself has
been affected by post-polio-paralysis. She personally knew the agony of being disabled. She was in
a good position to talk to Sivakumar’s parents and convince them for the surgery. Finally Sivakumar
had a successfully surgery thanks to the CBR Worker, Lakshmidevi.
Contd...
70 Community Based Rehabilitation of Persons with Disabilities
Contd...
Surgery alone was not sufficient for Sivakumar. There were a series of post-surgery tips to be taken
care of. Here again the CBR Worker brought the necessary inputs. With the help of Thirunavakarusu
(Specialist on locomotor disability) she introduced some home-based physiotherapy exercises. She
taught them to the parents who regularly practiced Shivakumar. Soon Sivakumar could notice remarkable
improvement on the contractures. Thirunavakarusu decided at the appropriate time to give Sivakumar
knee ankle foot orthosis (KAFO). This costs around Rupees 2500.
The family could not afford to pay the whole amount for the KAFO. This issue came up for discussion
at the CBR group meeting. The members at the meeting recommended that the family contribute
Rs. 300 and the project support the reaming Rs. 2200. This arrangement was acceptable to Sivakumar’s
parents. Very soon the KAFO was fabricated by MORE and was given to Sivakumar. After some initial
practice Sivakumar got used to the appliance.
Today Sivakumar is able to walk on his own to school. He is at class VII. He ensures that his step-
brothers also go to school with him. Sivakumar is doing well at his studies. He has made many friends
at school.
The CBR Group feels proud that it has enabled one of its children overcome disability. The community
feels no child should be left aside due to any impairment. They have ensured that Sivakumar has a
barrier-free environment at school. This means Sivakumar has a convenient seating arrangement in
the classroom.

Bhoolakshmi has different abilities


(By Eswar—Social Worker)
Bhoolakshmi (13) lives in a village called Bhadraiahgaripalle. Her father Siddappa (50) and mother
Siddamma (41) are small peasants who depend on agricultural labor. They have a small hut and less
than 4 acres of land Their livelihood is determent by the monsoons (annual rains) every year. Bhoolakshmi
has three older sisters who are married off in neighboring villages. Bhoolakshmi was born with visual
impairment. The doctors had declared there was no possibility of bringing any vision to her. Father
Siddappa says, “When I came to know that Bhoolakshmi will be blind forever I thought of deserting
her”. It was mother Siddamma who never entertained such thoughts. She brought her up like her other
daughters.
Four years ago when MORE set up the CBR Group at Bhadraiahgaripalle Siddamma became a member.
Through the CBR Group meetings Siddamma’s conviction that Bhoolakshmi’s disability should not be
a barrier for her development became stronger. This is where she interacted with the CBR worker,
Gulzar. Gulzar herself has partial sight. She was able to convenience Siddamma that Bhoolakshmi can
go to school. Siddamma and the rest of the Group members were astonished how a blind girl can
attend a regular school that was in their own village. All of them had thought that Bhoolakshmi could
only go to a special school for the Blind, which was 200 km away.
Gulzar explained in one of the CBR Group meetings about Inclusive Education. Fortunately the
schoolteacher, Yesodhamma also attended this meeting. Gulzar said, “Inclusive Education is nothing
but including all children in the pedagogy of the school. In any classroom all children will not have
the same caliber. Each one will have his or her own pace of learning. Some will have difficult subjects
and some will not. That does not stop the teacher from teaching the pupils. Similarly a child with disability
can also fit into the chain of different abilities of the children.” The schoolteacher was able to see the
point made by Gulzar. The schoolteacher promptly offered to take Bhoolakshmi into the school. The
whole CBR Group was fascinated.
When Bhoolakshmi attended school for the first time she was 9 years old. She was already 4 years
behind school. Nevertheless Bhooklakshmi was able to pick up many things at school thanks to Gulzar
Contd...
Planning and Implementation of Community-based Rehabilitation 71

Contd...
and Yesodhamma who gave special attention. Yesodhamma taught her many rhymes and a lot of lessons
by oral and aural methods. Gulzar started teaching simple brail. Today Bhoolakshmi has picked up
a lot of things at school. She has made many friends. One of her friends, Kasimvalli also lives in the
village. He has locomotor disability. Both Kasim and Bhoolakshmi have become a good example for
inclusive education in Bhadraiahgaripalle.
Apart from Brail Gulzar has taught Bhoolakshmi orientation and mobility. This enables her to use a
walking cane and move around in new surroundings. She is now well acquainted with the surroundings
in the village. Bhoolakshmi is on the way to becoming an independent person.

An Interesting Case Study from Mithrajyothi:


Ms. Pria belongs to one remote village of South Canara, Karnataka, India. She is a blind girl; she was
identified by one of our volunteers during her MSW training. She was not sent out of her house till
the age of 13 years. After convincing her parents she was brought to Mitra jyothi and made to join
independent living skill training for 4 months. During this period we found her capabilities, interest for
studies and willingness to study in the school.

After 4 months of training she went back to her home again doing nothing.
Again her parents were convinced to send her to school. Mithrajyothi provided active support for her
studies and convinced her parents. During her training period she was taught Braille script. Now, she
is 19 years old studying in one of the leading Colleges in Bangalore in 2nd year Pre University It is
really a success not only for both Mithrajyothi and Ms.Pria.

Ms. Madhu Singhal


Managing Trustee
Mithrajyothi
Bangalore, Karnataka, India
mjyothi@vsnl.com

CASE STUDY 1: Babu Vallon


Waste newspapers changed his life…This case is of how often simple solutions can change lives. Babu
Vallons case did not involve elaborate planning or heavy expenditure, but rather a very simple solution
which turned his entire life around, as the CBR staff of AIFO Cochin project found out.
Fifty-year old Babu has lived like a pariah in his own family all these years. Paralysed in the lower
limbs owing to polio, he suffered personal losses early in life with the death of his mother after his
birth. His father remarried and Vallon was brought up by his maternal relatives. Life however was not
easy. He moved from family to family, taking meals with one family, sleeping at another’s….always the
unwanted guest.
He tried several times to support himself. His first venture in repairing chairs with plastic wires failed
as the competition in the market for other varieties brought him no business.
He then obtained a tricycle to sell lottery tickets, but the difficult task of manoeuvring on the muddy
road in his Kaloor village soon forced him out of his attempt.
When the Cochin CBR staff came across his case, they decided to find a fool proof way to make him
economically independent. They hit upon the simple solution of providing newspapers for him to fashion
into covers.
Contd...
72 Community Based Rehabilitation of Persons with Disabilities
Contd...
As word spread, donations of old newspapers poured in and Vallon became a busy man fashioning
more and more covers for the CBR staff to sell for him. This simple solution has made a big difference
to Vallon, who is now happily engaged in an activity which has helped him become a contributing
member for the family he lives with. With the confidence arising out of his earning power, regardless
of the amount, today, it is Vallons turn to change lives as he teaches other persons with disabilities
to fashion covers out of waste newspapers and make them contributing members of the community.

CASE STUDY
What better case study can AIFO offer than its own CBR coordinator?
Thirty-four year Jayanth Kumar is a respected senior staff in the organisation taking an active part in
all major decision-making. His visual impairment has never been an issue of contention at the
organisation.
Independently handling the entire CBR work of AIFO in its over 40 projects in the country, Mr Jayanth
Kumar prepares reports , represents AIFO in seminars and workshops at both national and international
level. Not stopping at this, he travels independently into remote areas where AIFO projects are located
and holds training classes for CBR workers there.
Jayanth’s visual impairment was as a result of an accident in childhood. He dropped out of school
and tried in vain in the first three years to get his eyesight restored. When that did not happen, Jayanth
decided to make the best of the situation and enrolled in Shree Ramana Maharishi Academy for the
Blind (SRMAB), one of AIFO supported projects in Bangalore.
His rise from being a student in the academy to his present status as a senior staff at AIFO India, has
been meteoric, inspiring many to follow suit.
Yet, he too faced problems when he first ventured out into the world trying to get admission for
correspondence course in social work. Even to get one person to help him fill up the form was a
monumental and emotionally draining task!.
But that is all in the past. Armed with a master degree in sociology and diploma in community health
management, Jayanth forged on in his career gathering considerable experience on the way. He finally
caught the eye of AIFO representative Mr MV Jose when he was participating in a CBR activity in a
project of SRMAB. The rest, as they say is history….!

Case Studies from Kerala


Firos Ali is now 24 years old and he belongs to a socially and economically backward family residing
at this coastal area of Parappanangadi panchayat. He is the third child of his family. Firos Ali was
affected by polio when he was just 10 months old and his lower limbs were seriously paralysed. He
was not in a position to stand up and walk and so he was not admitted to any schools. He was an
illiterate boy when the field workers of the Seshy project identified him. He showed great interest in
learning to read and write. Our field workers motivated him and taught the alphabets and simple language
skills. Firos Ali received good support from his family members.
The field workers of Seshy project was very happy seeing the interest and smartness of the boy in
the academic matters. They motivated him to pass the SSLC examination. ‘Seshy’ gave him a tricycle
and he was very happy to wander around the coastal areas and hereby places riding his tricycle. He
gained great confidence moving around the much enthusiasm.
During the academic year 1997-98 he was asked to attend preparatory classes for SSLC conducted
by ‘Seshy’ for children with disabilities. A year long intensive coaching was given him. During the next
academic year, he was admitted to a parallel college to study the 10th Standard. He worked hard and
Contd...
Planning and Implementation of Community-based Rehabilitation 73

Contd...
passed the SSLC examination of 1998-99 in the third class. He then joined at P.S.M.O. College
Tirurangadi for the Pre-degree course opting commerce group. As he was poor in accountancy and
English he failed in the final examination.
Then he learned computer for 7 months. Seshy gave him financial assistance for setting up a STD
booth. Now he earns nearly Rs. 150/- per day. Meanwhile, he could buy three tier Kinetic Honda for
Rs. 25,000/-. He could mobilize Rs. 15,000/- for the parappanangadi Panchayat towards his purpose.

Case Studies from Kerala – II


Yaseen a boy with profound congenital deafness was just 2 years old when he was brought to community-
based rehabilitation center at parappanangadi for language and speech therapy. He has two elder
sisters who are also having congenital profound bilateral sensoni neural hearing loss. Yaseen was
given intensive and regular early intervention with the help of his mother. Eventhough, his mother had
the experience of two hearing impaired daughters, she was not thorough with the early intervention
programme earlier.
Yaseen was given three years continues language and speech therapy. His speech reading ability was
amazing. He used to wear pocket type hearing aid regularly. At the age of 5 he had mastered a good
functional language skills. Both his sisters were studying in special schools. But the parents and our
teachers decided to admit him to a normal school. Now Yaseen is studying in the Vth standard of a
U.P. school near his house. He is the pet of everyone and passes all subjects in ‘A’ grade itself.
Contact Person : Dr. V. Kunh Ahamed Kutty, Hon. President
ASSOCIATION FOR WELFARE OF THE HANDICAPPED
P.B. No. 59, Pavamani Road, Calicut – 673 001, Kerala
Ph: 0091 – 495-2720601, 2720434
Fax : 0091-495-2720028
Email: awhclt@sancharnet.in.

ASSIGNMENT FOR STUDENTS


Students choose a research question in Community-based rehabilitation and address it as
a small research project over period of month; under the guidance and supervision of a
teacher.

BIBLIOGRAPHY
1. David Werner: Disabled Village Children (Indian adaptation by VHAI), NIMH, Scunderabad.
2. David Werner: Nothing about us without us.
3. Einar Helander—Prejudice and Dignity (UNDP)
4. Maya Thomas and Pruthvish S (1993) “Identification and Needs Assessment of Persons with Disabilities in
Community Based Rehabilitation Initiatives “Monograph—ActionAid India.
5. Personal experiences while working with ActionAid India from 1992 till 1995 and 1996 till 2001.
6. WHO - Training of People with disabilities in the community (Package)
Supervision, Monitoring
and Evaluation of
Community-based
8 Rehabilitation
LEARNING OBJECTIVES
Participants should be able to differentiate supervision, monitoring, evaluation and
surveillance.
Participants should be able to list steps in evaluation of a community-based rehabilitation
programme; list indicators for monitoring and evaluating community-based rehabilitation.

OUTLINE OF CONTENT
• What is supervision?
• What is monitoring and surveillance?
• What is evaluation?
• What are reviews?
• Qualitative methods of evaluation—PRA methods; focus group discussion, attitude
measurement; case studies
• Quantitative methods of evaluation—survey methods; record analysis; functional
assessments
• Evaluation of coverage
• Evaluation of process
• Evaluation of impact
• Community-based rehabilitation indicators

SUGGESTED METHODOLOGY
Lecture Discussion; participation in an evaluation programme; participation in staff meetings
of CBR projects

PRE/POST EVALUATION
• Difference between supervision and monitoring?
• Difference between monitoring and evaluation?
• Why monitoring and evaluation?
• List quantitative and qualitative methods of evaluation.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 75

What is Supervision?
To watch over an activity or job to ensure that it is done correctly.
For example, supervisors watch over grassroots staff whether follow-up physiotherapy
is done correctly. Teachers of physiotherapy watch whether students correctly perform a
specific exercise of physiotherapy.

What is Monitoring and Surveillance?


By dictionary meaning, monitoring and surveillance mean almost the same. But in public
health practice, they have taken different connotations.
Surveillance means to watch over with great attention, authority, often with suspicion.
Surveillance requires professional analysis and sophisticated judgment of data leading to
recommendations for control activities, e.g. surveillance of vaccine preventable diseases.
Continuous scrutiny of the factors that determine the occurrence and distribution of
the diseases and other conditions of ill health.
Monitoring is the performance and analysis of routine measurements aimed at detecting
changes in the environment or health status of populations.
In management, monitoring refers to the continuous observation of activities to ensure
that they are proceeding according to plan. It keeps track of achievements, staff movement’s
and utilization, supplies and equipment and the money spent in relation to the resources
available so that if anything goes wrong, immediate creative measures can be taken.
Monitoring becomes one specific and essential part of surveillance/evaluation. Monitoring
requires careful planning and the use of standardized procedures and methods of data
collection and can then be carried out over extended periods by technicians and automated
instrumentation.
Monitoring involves collecting sample and relevant information to keep onself appraised
what are the changes noticed in the programme.
Monitoring may be monitoring of persons with disability for family or monitoring of
programme/project activities. It is of interest to note that both numbers and perceptions/
facts have been used as indicators of evaluations while measuring improved quality of life
of people with disabilities. One unique and essential feature in the monitoring and evaluation
of rehabilitation is that each PWD is to be measured against himself/herself to get a correct
picture.
Monitoring information helps the community-based rehabilitation worker keep track of
his or her own work and make simple day-to-day decisions about community-based
rehabilitation activities. It is part of daily routine of community-based rehabilitation and
not something special you do at the end of the year.
There have been attempts for developing indicators. Some examples of indicators are
given below:
• Number and percentage of PWD who have received ADLS training
• Number and percentage of PWD who had medical assessment
• Number and percentage of PWD who received aids and appliances
• Number and percentage of PWD who received physiotherapy
76 Community Based Rehabilitation of Persons with Disabilities

• Number and percentage of PWD who received speech therapy


• Number and percentage of PWD who are attending normal schools
• Number and percentage of PWD who are attending special schools
• Number and percentage of PWD receiving early intervention programmes
• Number and percentage of PWD who benefited from individual benefit schemes of the
Government
• Number and percentage of PWD who have received vocational counselling/training/
job placement
• Number and percentage of PWD participating in sports
• Number and percentage of PWD participating in cultural activities
• Numbers of PWD who are members of self-help groups
• Number of self-help groups formed.

What is Evaluation and What are Reviews?


Evaluation is the process by which results are compared with the intended objectives or
more simply the assessment of how well a programme is perfoming. Evaluation should
always be considered during the planning and implementation stages of a programme or
activity. Evaluation may be crucial in identifying the benefits derived. Evaluation may be
useful in identifying performance difficulties. Evaluation may be conducted for other
purposes too, e.g. attract attention of different stakeholders— micro-research for policy/
advocacy.
Reviews are similar to evaluations, latter are more systematically carried out and in
greater depth.
Monitoring is continuous activity. Evaluation can be done at different times during the
course of the programme—in the beginning, middle, and end. It can be pre/post/mid term
evaluation.
Recording systems help better monitoring and evaluation. In any community-based
rehabilitation programme, monitoring and evaluation should be inbuilt.
It is necessary that indicators are established to monitor and evaluate community-based
rehabilitation programmes. One of the ways indicators be arrived at are by referring to
targets arrived at by UNESCAP for the UN decade of disabled persons. Also, decadal
targets for the period 2003 to 2012. Or, indicators may be established locally—taking note
of activities of the programme.
Evaluation provides a systematic process of learning through experience. It also provides
a means to contractually use the lessons learnt to improve planning and implementation
of measures. Although both NGO and government have carried out many evaluation
exercises, documentation and dissemination have been relatively weak areas.
Evaluation is a process of learning and it cannot be a one-time activity. It has to be a
continuous process. The objectives of evaluation depend upon purpose and context. The
evaluation process has to be simple, less costly and capable of being undertaken even by
the grassroots staff in an organization.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 77

Evaluation is like an examination, it can be traumatic and often undesirable.


There is no uniform method for evaluation. The evaluation methodology needs to be
operations specific. The evaluation methodologies must themselves be evaluated.
Evaluation can be done by quantitative methods/qualitative methods/combined
methods. Evaluation may be done by external persons, by internal persons/both together.
A single method may not answer all questions. In order to get reliable data, one needs
to look at specific objectives, operations, decide the method of data collection, analyze the
data and its reliability. It is important to use a combination of different methods.
Evaluation may be participatory evaluation with all implementers. This will help capacity
building of all staff.

Conceptual Areas in Evaluation of Community-based Rehabilitation


Effectiveness: Changes in disabled people, families, and community’s outcome
Efficiency: Results vs. amount spent for rehabilitation
Impact: Overall impact on disabled people, families and community
Relevance
• Analysis of the approach used
• Analysis of strategy adopted
Sustainability: Policy and structural changes at government level/institutional sustainability
at community level.
Evaluation of coverage, process, output, outcome and impact are important. There is
need to develop uniform methodologies and develop indicators for evaluation so that results
will be comparable. Also, it is important that one has to make the exercise of evaluation
simple, relevant, less time consuming and not costly.

Parameters of Evaluation
In one of the consultations organized by ActionAid India, following were identified as
parameters of evaluation:
• Involvement of the community
• Organization of services (Institutionalization or formalization of services so that the CBR
programme is sustainable/delegation of powers/training)
• Financial sustainability
• Skill transfer to families and community
• How far the needs and aspirations of people have been met
• Adequacy of professional support and role of the support structure
• Structure/organization/human power
• Reliability in other areas
• Quality of life of PWD
• Extent of social integration
78 Community Based Rehabilitation of Persons with Disabilities

• Extent of reduction of disability (prevention is an important area)


• Changes in administrative structure, staff, knowledge and practices, legal changes,
outlook on the media
• Empowerment of PWD/family/community. Family to be looked at as a resource—extent
of reduction of burden/enrichment of the family needs to be reconsidered
• Equity, equalization of opportunities
• Impact of community-based rehabilitation workers
• Costing of Interventions, cost-effectiveness analysis
One needs to define empowerment, community participation before taking up evaluation.

Quantitative Methods of Evaluation


Quantitative data are useful especially for assessment of impact, coverage of persons with
different degrees of disability. Functional assessments and feedback on operations. Door
to door survey and analysis of secondary data can be used as quantitative methods. A
baseline must be established.
Development of questionnaires, use of interview method for data collection for house-
to-house survey; development of checklist for analysis of secondary data will constitute
prerequisites. One may cover entire population of catchment area or study on a sample
of the population. Simple random sampling and stratified random sampling has been used
in curtail evaluations while selecting people with disabilities to study their perceptions.
Functional assessments are possible using standard questionnaires (quantitative method),
e.g. FM questionnaires.
Following are some examples of indicators used for evaluations in the past:
• Rate of disabled people working/rate of disabled people not working (Lack of equal
opportunity)
• Educational levels of PWD vs. able bodied
• Increase in income level
• Percentage of PWD in whom increase in mobility/functional independence, etc. noticed
• Number of PWD who got vocational counselling/vocational training/employment
Often quantitative methods are adopted for evaluation. Using both quantitative and
qualitative methods together will help better understanding and comprehension.
Satisfaction, quality of life and gratification are difficult to be measured by quantitative
methods.

Qualitative Methods of Evaluation


Apart from open-ended unstructured and in-depth interviews, key informant interviews,
dairies, photographs and video films, qualitative information can also be obtained from
following methods.

Participatory Rural Appraisal (PRA)


Participatory rural appraisal is an approach, which will be useful in planning, monitoring
and evaluation of development programmes. It can be used for CBR programmes also. PRA
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 79

is the best available non-verbal communication system, which builds on available local
knowledge and practices, especially while dealing with people who are fewer literates.
PRA practitioners have developed a wide range of techniques based on the idea that
visualization can help participation. The starting point is thus the collective construction
of maps, matrices, calendars and diagrams on the ground using whatever materials are
locally available.
“Mobility mapping” is one of the tools used to assess the needs of a person with locomotor
disabilities. The person will be motivated to draw the rough sketch of his/her village with
some help from family members. The person will map mobility patterns using the village
map drawn on the ground. This activity enables us to assess the residual potential of the
person, his/her exact mobility pattern, constraints he/she has in going to the community
toilet, school, a friend’s house, the play ground, etc. Also, it is broad indicator of the kinds
of interventions that need to be planned for the individual, family and community to gain
better access to education, training and income generation and better social acceptance.
For further details see KR Rajendra (1999) and Somesh Kumar (2002).

Case Studies
Case studies are written summarily or synthesis of real life cases based upon data and
research.
• Require you to isolate and think through the key issues involved against both theory
and the larger comparative environment
• Identify appropriate strategies for the resolution of the ‘case’
• Weigh the pros and cons of the remedial options/strategies
• Recommend and present a rationale for the best resolution.
Case studies provide an opportunity to include illustrative histories, success stories and
the human element in evaluation reports. Please refer to case study format given at the
end of this chapter. This was one of the formats developed by ADD India. It is useful to
remember that one may adopt case study method only if we are sure that we are going
to intervene and help. Otherwise, it will simply contribute to raising aspirations without
follow-up support.

Focus Group Discussions


• Focus group research involves organized discussion with a selected group of individuals
to gain information about their views and experiences of a topic.
• Focus group interviewing is particularly suited for obtaining several perspectives about
the same topic.
• The benefits of focus group research include gaining insights into people’s shared
understandings of everyday life and the ways in which individuals are influenced by
others in a group situation.
• Problems arise when attempting to identify the individual view from the group view,
as well as in the practical arrangements for conducting focus groups.
80 Community Based Rehabilitation of Persons with Disabilities

• The role of the moderator is very significant. Good levels of group leadership and
interpersonal skill are required to moderate a group successfully.
Focus groups can be used at the preliminary or exploratory stages of a study (Kreuger
1988); during a study, perhaps to evaluate or develop a particular programme of activities
(Race et al., 1994); or after a programme has been completed, to assess its impact or to
generate further avenues of research. They can be used either as a method in their own
right or as a complement to other methods, especially for triangulation (Morgan, 1988) and
validity checking.
Focus groups can help to explore or generate hypotheses (Powell & Single, 1996) and
develop questions or concepts for questionnaires and interview guides (Hoppe et al., 1995;
Lankshear, 1993). They are however limited in terms of their ability to generalize findings
to a whole population, mainly because of the small numbers of people participating and
the likelihood that the participants will not be a representative sample.
For further details see article in Amita Gibbs “Social Research Update”.

Observation
Much can be learned by human behavior by observing it. Observation is most meaningful
when it is planned in terms of the formulated hypothesis and of the general scheme of
the study. Observation is helpful especially while doing “village studies:” Following methods
are in practice while following observation:
• Non-controlled, non-participant observation: Physical aspects of the community, social
atmosphere, symbiosis of the population and effects of such living in a social world will
be made by a external observer in Non controlled, non participant observation.
• Non-controlled participant observation: The participant observer shares to lesser degree the
life of the observed group. This sharing may be intermittent and, but active contacts
at close proximity afford intimate study of persons.
• Controlled observation: Controlled observation is generally carried out according to definite
prearranged plans, which may include considerable experimental procedure. A variety
of instruments have come to use—one way screens and mirrors, movement recorders,
sound recorders, motion pictures, rating scales, photographs, maps, observation checklists
and others.
Some of the most intensive studies have been in the area of child behavior. Using
observation methods will help determine change in attitude of a group, community.
Supposing village studies are done before and after CBR efforts, one may find the difference
in the way persons with disability are seen by the family members, self and community.

Attitude Measurement
Community-based rehabilitation has an important area to impact. That is attitude. Attitude
of persons with disability to himself/herself; towards kith and kin, community and vice
versa is the determining factor for the success of integrating persons with disability into
mainstream of society.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 81

Attitude measurement is a difficult task. But, sociologists and psychologists have made
it possible to measure the same. Suppose we measure attitudes before and after community-
based rehabilitation efforts, it will help determine success/otherwise of efforts. Licort scale
is one useful method to develop scales.
Attitude scales, morale scales, character tests, social participation scales, psychoneurotic
inventories have been developed by sociologists. In Allahabad university, an instrument
called DABB has been developed. It is a useful instrument to measure attitudes and of lot
of value for community-based rehabilitation work.

RHR CONSORTIUM MONITORING AND EVALUATION TOOL KIT


Focus Group Discussion Protocol
Purpose
The purpose of focus group discussions (FGDs) is to obtain information about community
members’ beliefs and attitudes on a particular health issue or problem. FGDs differ from
individual interviews in that the discussion allows for interaction among all the members
of the group. FGDs differ from surveys in that they permit participants to give detailed
opinions on a topic.

Description
Focus group discussions bring 6-12 people together for a discussion on a specific health
topic. The participants usually have some characteristics in common, such as sex and age,
so they will feel comfortable speaking in the group. For example, a focus group on the
topic of “how young people discuss condoms with their partners” might be made up of
women aged 15-19, while a separate group might be made up of men aged 15-19. It is
recommended that at least 2 FGDs be done with each group. So, in this example, 2 FGDs
with women aged 15-19 and 2 FGDs with men 15-19 are recommended.
An FGD typically lasts from 1-2 hours and is led by a trained facilitator. It is very useful
to have another person present who takes notes but does not participate in the discussion.
In addition, the FGDs should be recorded on audio tape or video cassette for later
transcription and analysis.

Ethical Considerations
Approvals: Before you being in a study, you must obtain certain permissions for ethical,
political and logistical reasons. Some groups you may need to obtain permission include
UNHCR, Ministry of Health, civil authorities in your district, community representatives,
your own organization, partner organizations and individuals interviewed.

Subscriptions for the Focus Group Discussion Protocol definition adapted from Alternative Modes of Teaching and
Learning, Case Studies, the University of Western Australia, Perth, Australia. http://www.csd.uwa.edu.au/altmodes/
to_delivery/casestudy.html
82 Community Based Rehabilitation of Persons with Disabilities

Informed consent: Every individual has the right to refuse to participate in a focus
group, or to stop her participation at any time. The focus group facilitator must respect
this right.
Privacy: Individuals should understand that participation in a focus group is a completely
voluntary activity and that even after the discussion begins they are free to leave. It is
important that the focus groups be conducted in a manner that is comfortable for all
participants, so that they are able to speak openly and honestly.
Confidentiality: All participants should agree at the start of the discussion that anything
discussed should remain in the group and is not to be discussed outside.
No identifying information should be kept in the notes or transcripts. This may mean
deleting names if they are used in the discussion.

Data Collection Guide


The FGD facilitator uses a discussion guide which describes the topics to be covered. The
discussion guide may contain examples of follow-up or probe questions for the facilitators;
this is particularly useful for new facilitators.
In an FGD, the facilitator should cover all the topic areas in the discussion guide, but
does not necessarily follow a particular sequence. The discussion should flow as naturally
as possible and some topics may be raised by group members. The facilitator should follow
the lead of the group members, probing topics they raise during the discussion.
The discussion guide should be pre-tested with a group of participants similar to the
ones you will be talking to later.
Click here for an example of a Focus Group Discussion Facilitator’s Guide.

Sampling Plan
Focus group discussions, like all qualitative methods, are not intended to be representative
of your population, so participants do not have to be randomly selected. Participants for
focus groups are invited to participate according to the characteristics you identify as
important for your topic. Anyone with the characteristics may participate, but keep the
focus group to a maximum of 12 participants.
In deciding what characteristics are important, think about the factors that
influence attitudes about your health topic as well as the characteristics that will make
people feel comfortable enough to talk openly with each other. Often, characteristics
like sex and age are important, for example, hold separate focus groups for men and
women and for younger and older participants. Other factors may also be relevant,
such as religion, educational level or length of time as a refugee, depending on the topic.
The more characteristics you select, however, the more focus group discussions will be
required, so select only the characteristics that, you believe, strongly influence your health
topic.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 83

Focus group participants are often recruited through local organizations or administrative
structure in the camp or community.

Data Collection Procedures


Location
Focus group discussions should be held in a location which provides as much privacy as
possible, where participants are comfortable and where it is easy for all participants to have
eye contact with each other and hear each other speak. Sitting in a circle is usually best.

Conducting the Group Discussion


Once a group of participants is assembled for the discussion, explain the discussion topic.
It is often useful to start with a broad health topic that is easy to discuss; more sensitive
topics can be raised as the discussion progresses and the participants feel more comfortable
with each other and with the facilitator.
If you are tape recording the discussion, get permission from the participants first and
make sure your equipment works; always carry extra batteries and tapes. Introduce the
notetaker and explain why he/she is there. Explain that no names will be used in the notes.
Focus group discussions should last 1-2 hours.
Click here for a brief Power Point presentation on Focus Group Discussions.

Facilitator Characteristics
Facilitators should be of the same sex as the focus group participants, and may need to
be close in age so that the participants feel comfortable talking openly. The study team
should discuss other characteristics of a successful facilitator, including:
• Language and communication skills
• Familiarity and comfort level while discussing reproductive health topics
• Ability to respect the dignity and confidentiality of respondents
• Previous experience with focus groups or other qualitative data collection methods.
Previous training and experience in sociology, anthropology, psychology or social
work may be helpful for focus group facilitators, as it is important that they have
good skills in listening in a non-judgmental and non-biased way. Getting beyond the
surface answers to the rich underlying information on attitudes, motivation, feelings
and self-perception is difficult, so care should be taken in selecting and training the
facilitators.

Facilitator Training
Allow at least two days for facilitator training, with an emphasis on field practice. At least
3 practice groups should be conducted by each facilitator. The study team should observe
the practice groups and give feedback to the facilitator.
84 Community Based Rehabilitation of Persons with Disabilities

Time Frame
It is best to keep the number of facilitators small—perhaps 1 to 2 male and 1 to 2 female
facilitators—to maintain good standards and to limit the variability introduced by the
facilitators. Each facilitator can conduct at most 2 to 3 focus groups per day, so the time
needed can be calculated according to how many facilitators there are and how many groups
are required.

Analysis Plan
Immediately after each focus group discussion, the facilitator and notetaker should meet
to review the main themes of the discussion. They should summarize patterns of responses
and confirm consensus or conflicts that emerged.
Next, the FGD notes should be typed, removing all identifying information such as
participants’ names. The audio or video tapes should be transcribed. If someone other than
the facilitators will do the analysis, she or he should listen to or watch the tapes in addition
to reading the transcripts.
Responses are analyzed by arranging them in the general categories identified in the
discussion guide. After the responses are arranged, the different positions or opinions can
be identified. The analysts can summarize the various opinions, assess the degree of
consensus or differences expressed by the groups and synthesize the themes or patterns
that emerge.

Use of Data
Focus groups can be used at various stages in a program. They can be used to explore a
new topic; to test ideas in the planning phase of a new program; to identify and solve
specific problems in an ongoing program; and to evaluate programs.
The results from the focus group discussions are intended to achieve the study objectives
and should be reported within that framework. The results should be used to make
decisions about the future of the project. It is important to highlight how focus group
discussion findings are consistent or inconsistent with findings from other sources of
information.

Dissemination
Results from the group discussions should be reported as they reflect the objectives of the
study. All the information collected should be relevant to the creation or modification of
current services to meet the needs of the refugees. Keeping this clear goal in mind should
assist the data analyst in organizing the final report.
A report of the findings of the focus group discussion should be prepared and shared
with project staff and partners. Dissemination to the community should also be done,
emphasizing that the results do not reflect any one person or area but are the synthesis
of many group discussion with many participants.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 85

FORMAT FOR CASE STUDY

Date of starting collection of Information:


State if the following details were given directly by the client or obtained from any other person (relative,
friend or any other) in case the client is a child or unable to give the information:

Name and address of


the disabled person:

Age:

Sex: Male/Female

Disability (specify):

Martial Status (Specify): Not married / married / widow /separated

Education (specify): Illiterate/Primary/Middle/High School/College/Technical Education (specify)

Belong to SC/ST/BC?

If yes, specify:

Occupation, if applicable:
Family details

Sl. Name Age Relationship Level of Occupation Employed Remarks


No. with client Education Skills Yes/No if any
1.
2.
3.
4.
5.

Total income of the family : Upto Rs. 6,000 per year _________
(specify) Rs. 6,000 – 12,000 per year _____
Rs. 12,000 – 24,000 per year ________
Rs. 24,000 and above per year ________
86 Community Based Rehabilitation of Persons with Disabilities

HISTORY OF HEALTH / DISABILITY


1. Where was he/she born – at home, a hospital or any other place?
2. Any complication, if known, before and/or during birth, e.g. low birth weight, cord around neck,
delayed birth cry etc.
3. Were his/her parents related to each other before marriage (consanguineous marriage)?
4. Any health problems in childhood: Jaundice, Head injury, Chickenpox, Meningitis (brain fever),
Typhoid, Malnutrition or any other?
5. Immunisation taken: BCG, Polio, DPT, Measles, MMR, any other or none?
6. The age at which disability was identified, the first symptoms noticed, and if parents know the reason/
cause of disability?
7. Interventions made : a. Medical treatment at PHC/Hospital
b. Faith healers
c. Any other
d. None
8. Present condition of disability, including the person’s ability to manage activities of daily living.
9. Relationship with family members (give details as described/felt by the client):
With Father/Mother: health, occupation, personality, quality of relationship with the client, including
attitude of the parents towards the disabled person and vice versa.
With children (sons/daughters), if applicable: Occupation, personality, quality of relationship with
the client.
Social position of the family: Family structure, economic status in the community, occupation, habits,
pattern of decision-making, existing role structure in family.
10. The following may be asked/observed while talking to the client/informant:
a) Interaction of the family members with the client; relationship with spouse and, if relevant, about
their divorce, remarriage; rivalry between siblings, favouritism of one child by the parents; recent
events in the family which may have been stressful to the client.
b) Problems in the family related to family needs and issues related to role, responsibility and
behaviour of the disabled person and/or family and society. How such problems are managed.

PERSONAL DETAILS
1. Schooling:
a. Records showing intellectual or mental development.
b. Social, physical, emotional and moral development
c. Age of starting and finishing primary and high schools.
d. Relationship with teachers and pupils
e. Whether he/she had friends and was popular
f. Whether he/she played games.
g. Similar questions to be asked about higher education.
2. Use of leisure time : Hobbies and interests.
3. Relationship: With friends, with peer groups, superficial or close, own or with the opposite sex;
relationship with relatives and in society.
4. Habits: Food, use of alcohol, tobacco, drugs, disturbed sleep.
5. Occupation, if applicable:
a. Information about present job (if employed or self-employed)
b. Whether he is under stress at work.
c. Information about relationship with colleagues (senior and junior)
d. Skills the client has.
e. Credit facility taken, if any.
Contd...
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 87
Contd...
If unemployed – why? Are there any immediate plans for employment?
6. Present family circumstances:
a. Question on housing – do they own it or rent it?
b. Finances.
c. To understand the client’s circumstances.
d. What aspects of his/her life are stressful and how is the disability affecting him/her.
7. The disability worker may observe the following:
a. To know the personality of the client: General knowledge, wishes, ego, strength, sense of
tolerance, co-operation, sensitivity, adaptability, communication patterns, sympathy, responsibility,
expression of emotions, devotion and motivation to work, level of aspirations and weaknesses
in his personality.
b. To know the mood/character of the client: Cheerful or gloomy, anxious, worrying, over-confident,
sensitive, suspicious, jealous, shy, self-conscious, dependent, rigid etc.

ACTION PLAN
1. Client’s efforts to solve his/her problem Disability Worker/Social Worker should know the efforts made
by the client to deal with his problem; the help taken so far from organizations, agencies and others;
effects of help received; client’s opinion towards these and other agencies and on the help received.
2. Reasons for the present condition of the client and root cause of the disability, as perceived by
the client/informant – whether it is political, biological, psychological or economic.
3. Problematic areas as perceived and agreed upon by the client family members and the Disability/
Social Worker.
4. Analysis by the disability worker of the situation/problem, based on the data / details collected
5. Client’s future plan
a. What does he/she feel and thinks about him/herself?
b. What does he/she want to do and how is he/she planning to achieve this?
c. Whether the family members have any other plans for his/her future?
6. Implementation of Action Plan: What, How, When, Where and by who (made in consultation with
the client and family members?
1.
2.
3.
4.
7. Follow-up action

Date Intervention Type of help Remarks


made rendered

Source: ADD India (2001) Building Abilities Mr.Ramachandra, Executive Director, ADD India, Action
on Disability and Development (ADD) India 4005 19 Cross, Banashankari II Stage Bangalore 560 070

Publishers: Books for Change – A Unit of ActionAid Karnataka Projects, Skip House, 25/1 Museum
Road Bangalore 560 025
88 Community Based Rehabilitation of Persons with Disabilities

ASSIGNMENT FOR STUDENTS


1. Developing checklist for monitoring—Individual and community
2. Developing checklist for focus group discussion
3. Doing 3 case studies of disabled persons
4. This exercise needs to be given only if the organization helps/supports persons with
disability.

BIBLIOGRAPHY
1. Anita Gibbs, Social Research Update, Department of Sociology, University of Surrey, Guildford GU7 5XH,
England.
2. Identification and Needs Assessment of Beneficiaries in Community Based Rehabilitation Initiatives, Maya
Thomas, S Pruthvish, Monograph, ActionAid India, 1993.
3. Morgan, David L., Focus Groups as Qualitative Research, Sage, Thousand Oaks, CA, 1997.
4. Pauline V Young, Scientific Social Surveys and Research, IV Edition, Prentice Hall of India Private Limited,
New Delhi 1992.
5. Pruthvish S. (1998) “Programme Development in CBR and Resultant Social functioning abilities”, ActionAid
Disability News, Vol. 9, No.1, 1998.
6. Pruthvish S. and Maya Thomas: (1993) Identification and Needs Assessment of Beneficiaries in Community
Based Rehabilitation Initiatives, ActionAid Disability News, Vol. 4, No.1, 1993.
7. Pruthvish S. Maya Thomas, Thomas M. J: (1996), Identification Survey in twelve ActionAid Supported CBR
Projects - A discussion on the prevalence of different Disabilities, ActionAid Disability News, Vol. 7 (1), PP
21-22.
8. Pruthvish S. Maya Thomas, Thomas M. J: (1996), Prevalence of Disability in ActionAid supported CBR Projects
and its significance in Program Planning, ActionAid Disability News, Vol. 7 (1), PP 23-24.
9. Pruthvish, S. and Maya Thomas: (1992), Research in Rehabilitation—Proposed Strategies of Disability Division,
ActionAid Disability News Vol.3, No.2, 1992.
10. Rajendra KR, Application of PRA for Therapeutic Interventions in Disability Rehabilitation, ActionAid Disability
News, Vol 10, No 1 and 2, 1999.
11. Somesh Kumar (2002) PRA.
12. Uma Thuli, Pruthvish S., Maya T homas, Joseph Panarkel (1996), Identification and Needs Assessment at
Amar Jyothi CBR Project - ActionAid Disability News, Vol.7 (1): 16-17.
Resources for CBR
and Disability
9 Rehabilitation
LEARNING OBJECTIVES
• Participants should be able to list resource materials, resource organizations in CBR
• Participants should be able to access resource materials using internet

OUTLINE OF CONTENT
• Summaries of useful resource organizations/projects
• List of reference books, periodicals, journals, slides, video films that will be useful
• List of resource organizations and their work across the country/abroad
• List of useful websites and internet links

SUGGESTED METHODOLOGY
• Sharing list of resource materials/resource organizations
• Visiting resource organizations
• Library work
• Browsing internet

PRE/POST EVALUATION
• List useful resource books/journals in community-based rehabilitation
• List useful organizations/projects undertaking community-based rehabilitation
• Have you accessed useful websites?

List of Publications of WHO


1. WHO, Rehabilitation team “Rethinking Care” for the perspective of disabled people.
2. WHO/RHB 96.1 Disability Prevention and Rehabilitation: A guide for strengthening
the Nursing Curriculum.
3. WHO/RHB 94.1 Community Based Rehabilitation and the health care referral services.
4. WHO/DAR/99.2 Prompting Independence following a stroke: A guide for therapists
and Professionals working in Primary Health Care.
90 Community Based Rehabilitation of Persons with Disabilities

5. WHO/RHB/96.3 Guidelines for Conducting, Monitoring and self assessment of


Community-based Rehabilitation.
6. WHO and SHIA Part I Community Based Rehabilitation as we have experienced it .
7. WHO and SHIA Part II Community-based Rehabilitation as we have experienced it.
8. WHO/DAR/01.7 The UN Standard Rules on the Equalization of Opportunities for
persons with disabilities: government responses to the implementation of the rules on
medical care, rehabilitation, support services and personnel training: Regional Report
SEARO.
9. ILO, UNESCO, WHO: Community-based Rehabilitation: For and with people with
disabilities Joint position paper 1994.
10. WHO/RHB/97.2 Cost Analysis for Management of Rehabilitation Programmes.
11. WHO/DAR/02.1 Equal opportunities for All: Promoting Community-based
Rehabilitation (CBR) among urban poor populations.
12. WHO/RHB 97.1 Let’s Communicate: A handbook for people working with children
with communication disabilities.
13. WHO/DAR/01.1 The UN Standard Rules on the equalization of opportunities for
persons with disabilities: government responses to the implementation of rules on
medical care, rehabilitation, support services and personnel training I. Summary.
14. WHO/DAR/99.1 Prosthetics and Orthotics services in Developing countries—A
discussion document.

List of Existing Community-based Rehabilitation Programmes, Studies and


Evaluations Prepared by Birgitta Jennische, Uppsala University
1. Boyce W. Research and evaluation in community-based rehabilitation: an integrated
model for practice. Asia Regional Symposium on Research and Evaluation in community-
based rehabilitation, Bangalore, India, December 5-7, 1994. Kingston, Ont.: Queens
University, 1994.
2. Brar B. Research and evaluation in community-based rehabilitation. Some views derived
from UNICEF experience. ActionAid Disability News, 1992, 3(2): 35-41.
3. Brouilette R, Mariga L. Community-based approach for individuals with mental
handicap: an African experience. Brussels: ILSMH, 1993.
4. Carraro L. The community-based rehabilitation programme in Mongolia. Asia Pacific
Disability Rehabilitation Journal, 1997, 8(2): 41-43.
5. Chidyausiku S. Community-based rehabilitation programmes in Zimbabwe. Sida
evaluation: 1998:15. Stockholm: Sida, 1998.
6. Dalal A, Berry J, Attitudes, beliefs and behaviours in relation to CBR programmes:
a cross-cultural perspective. Asia Regional Symposium on Research and Evaluation in
CBR, Bangalore, India, December 5-7, 1994. Bangalore, 1994.
7. Finkenflugel H, ed., The handicapped community: The relation between primary health
care and community-based rehabilitation. Amsterdam: VU University Press, 1993.
8. The future of CBR: crucial issues. Rehabilitation International Asia Pacific Region Pro-
Conference Workshop, September 7-10, 1995, Solo, Indonesia. Solo: CBR Centre, 1995.
Resources for CBR and Disability Rehabilitation 91

9. Gautron B, Krefting L, O’Toole B, Guidelines for conduction, monitoring and self-


assessment of community-based rehabilitation programme: using evaluation information
to improve programmes. Geneva: WHO, 1996.
10. Gilbert-Westholm M, Community-based rehabilitation: A study of evaluation reports.
Lund: Lunds Universitet, 1994.
11. Gulden A, Hedengard H, Community-based rehabilitation in Vietnam: an evaluation
of the benefits for the individual. Minor field study report. Stockholm: Karolinska
Institutet, 1994.
12. Gunawardena M, Saunders C, An evaluation of the MENCAFEP community-based
rehabilitation programme, Nuwara Eliya, Sri Lanka. London: Save the Children Fund,
1990.
13. Hastriim C, “Community-based rehabilitation—a good rehabilitation alternative for
children with polio?” Title in Swedish: “Community-based rehabilitation—ett bra
rehabiliteringsalternativ for poliodrabbade barn?: ettjamforande arbete om barn med
polio: intervjuer med fysioterapeuter som arbetat med rehabilitering i u- lander. Oslo:
BisletHoyskolecenter, 1993.
14. Ingstad B, An evaluation of community-based rehabilitation in Kweneng District,
Botswana: A half-way report from a research project. Oslo: University of Oslo, 1984.
15. Johansson E, Community-based rehabilitation in Zimbabwe: A case study. Minor field
study report. Stockholm: Karolinskalnstitutet, 1994.
16. Khalfan KH, Lang R, Community-based rehabilitation in Zanzibar. CBR News, 1992,
(12):4-5.
17. Kristiansson B, Liljestrom R, Report on an evaluation mission of community-based
rehabilitation in Vietnam, April 4-May 2, 1993. Stockholm: Radda Barnen, 1993.
18. Kwok J, The role of the family, in disability concerned policies and services: challenges
for community-based rehabilitation in the Asian and Pacific Decade of Disabled Persons,
1993-2002. International Journal of Rehabilitation Research, 1995, 18(4):351-356.
19. Lagerkvist B, Community-based rehabilitation outcome for the disabled in the
Philippines and Zimbabwe. Disability and Rehabilitation, 1992, 14(l):44-50.
20. Lagerwall T, Review of community-based rehabilitation services run by the Ministry
of Health in Kenya. Vallingby: Swedish Handicap Institute, 1992.
21. Laigret D, Community-based rehabilitation Zanzibar: assignment from 15 January to
23 April 1990. Geneva: WHO, 1990.
22. Leavitt RL, Disability and rehabilitation in rural Jamaica: an ethnographic study.
Cranbury, NJ: Associated University Press, 1992.
23. Lindstrom A, Lagerwall T, Report from seminar on community-based rehabilitation
(CBR). RIPre-congress Seminar in Limuni, Kenya, August 31-September 3, 1992.
Vallingby: Swedish Handicap Institute, 1993.
24. Making it happen: examples of good practice in special needs education and community-
based programmes. Paris: UNESCO, 1993.
25. Mendis P, Evaluation of community-based rehabilitation development project in Tiang
Giang and Ho Chi Minh: report of assignment 24 February-24 March 1988. Stockholm:
Radda Barnen, 1988.
92 Community Based Rehabilitation of Persons with Disabilities

26. Mageje N, Pedersen S, Community-based rehabilitation: presentation of a Tanzanian


approach: experiences from Ukerewe district. Arusha: CHAWATA, 1992.
27. Menon DK et al. Evaluation of community-based rehabilitation programmes: the NIMH
experience. ActionAid Disability News, 1993, 4(2):7-11.
28. Miles M, Community-based rehabilitation: information, accumulation and exchange:
South Asian research notes. Paper prepared for Symposium on a community-based
rehabilitation Evaluation and Research, Bangalore, India, Ekcember 1994. Bangalore,
1996.
29. Ministry of Health, Disability Unit, A report on eight community-based rehabilitation
pilot projects. Harare: Government of Zimbabwe, 1990.
30. Mutangira JPB, Nkosi LF, Swaziland community-based rehabilitation (CBR) programme:
an evaluation report for Ministry of Health, Swaziland, and Save the Children Fund.
Mbabane: Ministry of Health, 1993.
31. Nilsson H, Community-based rehabilitation in Kenya: a follow-up study. Minor field
study report. Uppsala: ICH, 1993.
32. OToole B, Development and evaluation of a community-based rehabilitation
programme for pre-school disabled children in Guyana. Georgetown: University of
Guyana, 1989.
33. OToole B, “Step by step” a community-based rehabilitation project with disabled
children in Guyana. New York: UNICEF, 1990.
34. OToole B, I will I can: participatory evaluation Ghana community-based rehabilitation
programme, Ghana, March 13th to April 13th 1996. Geneva: UNDP, 1996.
35. Owako RO, How has community-based rehabilitation been implemented as a component
of primary health care? London: ICH, 1995.
36. Peat M, Community-based rehabilitation: components for evaluation. Kingston, Ont.:
Queens University, 1993.
37. Pupulin E, Mission report Kenya 20-27 February 1992. Geneva: WHO, 1992.
38. Rajendra KR, Rahman N, Mid-term evaluation of Protibondhi Kallyan Somiti
community-based rehabilitation project located in Bangladesh. Part 1: Methodology and
process. ActionAid Disability News, 1998, 9(l):l-17.
39. Rajendra KR et al., The Sourabha community-based rehabilitation project an evaluation
study. ActionAid Disability News, 1994, 5(l):67-73.
40. Rao P et al. Community-based rehabilitation services for people with disabilities: an
experimental study. International Journal of Rehabilitation Research, 1993, 16(3):245-
250.
41. Saunders C, Zinkin P, Evaluation of the Kibwezi community-based rehabilitation
programme, run jointly by ActionAid, AMREF and the Government of Kenya. London:
ICH, 1990.
42. Strengthening community-based rehabilitation as an integral part of primary health care.
43. Report of Regional Workshop, New Delhi, 3-6 December 1996. New Delhi, 1997.
44. Stubbs S, ed. Evaluation: Save the Children Fund UK Baglung mother and child health
programme CBR component. London: Save the Children Fund, 1993.
Resources for CBR and Disability Rehabilitation 93

45. Thomas M, Community-based rehabilitation and community development. Bangalore:


ActionAid India, 1995.
46. Thorburn MJ, Parent evaluation on community-based rehabilitation in Jamaica.
International Journal of Rehabilitation Research, 1992, 15(2):170-176.
47. Thorburn MJ, Factors influencing the response to CBR by parents. Meeting on
Evaluation of CBR, Bangalore, India, December 5-7, 1994. Spanish Town, 1994.
48. Thorburn MJ, Marfo K, Practical approaches to childhood disability in developing
countries. Tampa, FL: Global Age Publishing, 1994.
49. Tull U et al., Discussions on some findings from the evaluation of Amarjyoti CBR project.
ActionAid Disability News, 1996, 7(l):25-26.
50. United Nations Office at Vienna, Centre for Social Development and Humanitarian
Affairs, Community-based rehabilitation: the past, the present and the future. Report
on Seminar in Benin, 10-15 November 1991. Vienna: UNOV/CSDHA, 1991.
51. Vanneste G, Community-based rehabilitation in Africa: a critical review of the emerging
scene. Asia Pacific Disability Rehabilitation Journal, 1997, 8(2):34-37.
52. Werner D, Observations and comments on the Kisumu CBR programme. Palo Alto,
CA: Hesperian Foundation, 1992.
53. WHO Regional Office for Europe, Community-based rehabilitation report of a WHO
consultation, Jerusalem, 15-17 January 1990. Copenhagen: WHO, 1990.
54. Yaday BP, Proposed modus operandi, monitoring and evaluation for effective CBR in
India. National Seminar on Disability Prevention, Trauma Care and Rehabilitation with
Special Reference to Community-based Rehabilitation, March 7-11, 1994. New Delhi:
Directorate General of Health Services, 1994.
55. Zhuo D, A decade of community-based rehabilitation in China. ActionAid Disability
News, 1998, 9(l):5-7.
While there are numerous books on evaluation in general and detailed methodology,
the books and articles listed below are those which could be most helpful to a community-
based rehabilitation co-ordinator or manager.
1. Barlow DH, Hayes SC, Nelson RO. “The Scientist Practitioner, Research and
accountability in clinical and educational settings”. New York, Pergamon, 1984.
Excellent analysis of how best to combine the roles of being a practitioner and
attempting to evaluate the effectiveness of the work.
2. Bidder RT, Hewitt KE, Gray OP. “Evaluation of teaching methods in a home based
training scheme for developmentally delayed pre-school children”, Child: Care, Health
and Development, 1983;9:1-12.
Analyses-whether detailed objectives are an essential part of a programme’s success.
3. Cronbach LJ. “Designing evaluation of educational and social programmes”, London,
Josey Bass, 1982.
Useful book concerning how to carry out an evaluation of a project.
4. Cronbach LJ. “Beyond the two disciplines of scientific psychology”, American
Psychologist, 1975;30:116-127.
94 Community Based Rehabilitation of Persons with Disabilities

The author, previously a major supporter of a statistical model of evaluation,


advocates more qualitative approaches.
5. Grimby G, Finnstam J, Nelson G, Rashid S. “Evaluation of Community Based
Rehabilitation in Punjab, Pakistan, I and II”, International Disability Studies. 1988;10(2):
54-60.
This paper illustrates one way of using the monitoring forms in the WHO materials
as part of a programme evaluation.
6. Feurstein MT. “Partners in Evaluation: evaluating development and community
programmes with participants”, London, MacMillan Publishers, 1988.
This is one of the most accessible and useful references in the field of evaluation.
It is available from TALC, (Teaching Aids at Low Cost), PO Box 49, StAlbans, Herts,
ALI 5TX, UK.
7. Hegarty S, Evans P. “Research and evaluation methods in Special Education”, NFER,
Nelson, 1985.
Very clear introduction to important issues in evaluation.
8. Helander, E., Mendis, P Goerdtl A, Nelson, G. “Training in the Community for People
with Disabilities”, WHO, Geneva, 1989.
The Guide for Local Supervisors has a number of valuable forms for monitoring
an evaluation.
9. Jonsson T. “OMAR in Rehabilitation”, UNDP, Geneva, 1995.
Ture Jonsson has produced a detailed and systematic approach to evaluation that
is based on the WHO Manual. The booklet includes a user-friendly computer disk to
olio- easy analysis of data.
10. Krefting L. “Assessing the Trustworthiness of Qualitative Research’ American Journal
of Occupational Therapy, 1991; 45:24-28.
This article describes specific strategies to increase the rigor of qualitative research.
11. Kroeger A. “Anthropological and social medical care research in developing countries”.
Social Science and Medicine, 1983; 17(3): 147-161.
Detailed analysis of the effectiveness of Primary Health Care projects.
12. Patton MQ. “Qualitative Evaluation and Research Methods”, Second Edition, SAGE
Publications, 1990 Available from SAGE Publications, 2455 Teller Rd, Newbury Park,
California, USA 91320 or SAGE Publications India Pvt Ltd. M 32 Market, Greate Kailash
I, New Delhi, 100 048, India..
This is one of the most comprehensive and yet accessible books on qualitative
research and evaluation. It covers concepts as well as design, information gathering,
an analysis, interpretation and reporting. It is filled with examples from education,
social services and development projects and gives a number of practical suggestions.
It is pea of a larger collection of monographs on evaluation, most of which are very
useful.
13. Soeharso community-based rehabilitation. Development and training centre.“Finding
out if your programme works: evaluating community-based rehabilitation programmes”.
Solo community-based rehabilitation Training Centre, Indonesia, 1995.
Resources for CBR and Disability Rehabilitation 95

This is one of 20 manuals about community-based rehabilitation written for field


workers and trainers. It contain learning activities, case examples and illustrations.
14. Yach D. “The use and value of qualitative methods in health research in developing
countries”. Social Science and Medicine 1992;35(4):419-424.
A useful resource using case examples to illustrate the merits of qualitative research
especially its strengths as compared to quantitative methods.
15. ILO, UNESCO, WHO. “Joint Position Paper on community-based rehabilitation for and
with People with Disabilities”, WHO, Geneva, 1994.
This is a very valuable position paper which presents a common view of what
Community Based Rehabilitation is in theory and practice.

List of Important Organisations in India


1. Action of Disability and Development India (ADD)
4005, 19th cross
Banashankari II Stage
Bangalore—560070
E-mail: addindia@vsnl.com
2. Ali Yavar Jung Rashtriya Shravan Viklang Sansthan (AYJNIHH)
Kishanchand Marg
Bandra Revlameshan, Bandra
Bombay—400 050
Maharashtra
3. All India Institute of Physical Medicine and Rehabilitation
Haji Ali Park
Clerk Road, Mahalaxmi
Bombay—400 034
Maharashtra
4. All India Institute of Speech and Hearing
Manasagangotri
Mysore—570 006
Karnataka
5. Amar Jyoti Charitable Trust
N 192, Greater Kailash –I
New Delhi—110 048
6. Amar Jyoti Research and Rehabilitation Centre
Karkar Dooma
Vikas Marg
New Delhi—110 092
7. Andh Maha Vidyalaya
Panchkuian Marg
New Delhi—110 001
96 Community Based Rehabilitation of Persons with Disabilities

8. Andh Mahila Sabha Iswari Prasad


Dattatreya Orthopaedic center
3, Adyar Bridge Road
Chennai—600 028
Tamil Nadu
9. Association of the Physically Handicapped
11, Hennur Road,
Lingarajapuram
Bangalore—560 001
Karnataka
10. Bala Vihar Training School
Halls Road, Kilpauk
Chennai—600 010
Tamil Nadu
11. Bala Vikas Institue
Gandhi institute
Opp. Hindustan Latex
Peroorkada
Trivandrum—695 005
Kerala
12. Balwant Ray Mehta Vidya Bhawan
Masjid Moth
Greater Kailash—II
New Delhi—110 048
13. Burns Society of India
103, Vijay Apartments
Bulabai Desai Road
Mumbai—400 036
14. Centre for Special Education
Opp. Afghan Church
Upper Colaba Road, Colaba
Mumbai—400 005, Maharashtra
15. Centre for Special Education
C/o N. V. Gadgil School
No. 5, Near Dakshin Mukhi Maruti,
Shaniwarpeth
Pune—411 030
Maharashtra
16. Centre for Special Education
Thakkar Bapa Vidyalaya Campus
36 Venkatanarayana Road
T Nagar, Chennai—600 017, Tamil Nadu
Resources for CBR and Disability Rehabilitation 97

17. CHETNA
Sector C, Aliganj Housing Scheme
Lucknow—226 020, Uttar Pradesh
18. Chetna Institute for the Mentally Handicapped
Lakshmi Vihar
Bhubaneshwar—751 005
Orissa
19. Child Development and Research Centre
AD –80, 5th Avenue
Anna Nagar
Chennai—600 040, Tamilnadu
20. Child In Need Institute
Vill. Daulatpur, P.O. Amagachi
Via: Joka
Dist. 24 Paragana (S)
West Bengal—743 512
21. Children’s Orthopaedic Hospital
Haji Ali Park
Clerk Road, Mahalaxmi
Bombay—400 034
Maharashtra
22. Christian Medical College
Dept. of Physical Medicine and Rehabilitation
Vellore
Tamilnadu
23. Deepshikha
70, Circular Road
Opp. Women’s College
Ranchi, Bihar
24. Don Bosco Prem Nivas
Mangalagiri—522 503
Guntur Distt.
Andhra Pradesh
25. Education and Training Institute for Mentally Retarded Children
29/24 Nandanavan Society
Race Course Road
Athwa Lines,
Surat, Gujarat
26. Gandhi Memorial Leprosy Foundation
Hindinagar, Wardha—442 103,
Maharashtra
98 Community Based Rehabilitation of Persons with Disabilities

27. Gandhi Rural Rehabilitation Centre


Alampoondy, Gingee Taluk
South Arcot dist.
Tamilnadu—604 151
28. Govt Home For The Crippled Children
Near Waterworks
P.O. Harsool
Aurangabad—431 001
29. Helen Keller Institute for the Deaf and the Deaf- Blind
Municipal Secondary School (South Wing)
N.M. Joshi Marg,
Near Sandhurst Bridge,
Byculla (W), Bombay—400 011

RESOURCES FOR PROGRAMMES FOR THE MENTALLY III

Funding Support
The national mental health programme for India formulated by the Ministry of Health in
1982 forms the main policy framework for mental health programme. Support can be
obtained from the NMHP funds.
The drug dependence programmes are funded both by the Ministry of health and
Ministry of welfare. The funding is available for counselling centres, detoxification centres
and deaddiction centres, along with training programmes.
The activities related to rehabilitation and suicide prevention are supported by Ministry
of welfare. The support for mental retardation work is also available from ministry of
welfare.
The resource centres available for the above mental health activities are:
1. National Institute of Mental Health and Neuro Sciences,
Post Bag No. 2900,
Bangalore - 560029.
2. National Institute of Mentally Handicapped
Manovikas Nagar.
P.O. Bowenpallv.
Secunderabad - 500011.
3. SANJIVINI
A 6, Institutional Area,
Satsang Vihar Marg,
South of IIT.
New Delhi 110067.
4. Schizophrenia Research Foundation (India),
No. C-46, 13th Street,
East Anna Nagar,
Madras - 600102.
Resources for CBR and Disability Rehabilitation 99

5. Department of Psychiatry Niloufer Hospital


4-8-812, Gowliguda
Hyderabad - 500012.
6. Medico Pastoral Association
18/1, Pottery Road
Frazer Town,
Bangalore - 560 005.
7. Department of Psychiatry
All India Institute of Medical Sciences,
Ansari Nagar
New Delhi - 110029
8. Division of Mental Health
World Health Organisation
CH-1211, Geneva 27,
Switzerland.
9. Regional Advisor on Mental Health
World Health Organization
South East Asia Regional Office
World Health House, Indraprastha Estate
New Delhi - 110002.
10. Tata Institute of Social Sciences
Post Box No. 8313
Deonar
Bombay - 400 088.
11. SNEHA
21, Ranjit Road
Kottupuram
Madras - 600 085.
12. Division of Non-Communicable Diseases, Indian Council of Medical Research
P.B. No. 4508, Ansari Nagar
New Delhi - 110029.
13. Central Institute of Psychiatry
P.O: Kanke
Ranchi 834006.
14. AMEND
L-188, 9th A Main
Sector II, HAL III stage
Jeevan Bheema Nagar
Bangalore - 560 075.
15. ANTARA Psychiatric Centre
P.O. Dakshin Gobindapur
P.S. Baruipur, 224 Parganas (S)
West Bengal.
100 Community Based Rehabilitation of Persons with Disabilities

16. Paripurnata
5 B, Maharani Swarnarnoyee Road
Calcutta - 700009
West Bengal.
17. Department of Psychiatry Postgraduate Institute of Medical Education and Research
Chandigarh 160012.
18. Indian Law Institute,
Bhagwandas Road,
New Delhi - 110002.
19. Department of Psychiatry
B.Y.L. Nair Ch. Hospital and T.N. Medical College
Bombay - 8.
20. Department of Psychiatry
S.N. Medical College,
Jodhpur.
21. Institute of Human Behaviour and Allied Sciences
G.T. Road, Shahdara
Delhi - 110095.
22. National Addiction Research Centre
Floor 5, Hardawadi Hospital
Bhardawadi Road, Andheri (W)
Bombay - 400 058.
23. TTR Education Foundation
TTK Hospital
17, IV Main Road
Indira Nagar,
Madras - 600 020.
24. Dr. R.N.Cooper Hospital and
Seth G.S. Medical College
Bombay - 400 056.
25. Mental Health Centre
Christian Medical College and Hospital
Vellore.- 632002
Tamil Nadu.
26. Maharashtra Institute of Mental Health
Sasoon Hospital
Pune,
Maharashtra.
27. Department of Psychiatry
SMS Medical College
Jaipur - 302004.
Rajasthan.
Resources for CBR and Disability Rehabilitation 101

28. Institute of Mental Health


Erragadda
Hyderabad - 89
Andhra Pradesh.
29. Institute of Mental Health
Kilpauk
Madras - 400010
Tamil Nadu.
30. Department of Psychiatry
Guwahati Medical College and Hospital,
Guwahati (Assam).
31. The Richmond Fellowship Society India.
‘ASHA’, 501, 47th Cross,
Jayanagar, 5th Block,
Bangalore - 560041.
32. Voluntary Health Association of India (VHAI)
Tong Swasthya Bhavan
40, Institutional Area
(Behind Qutab Hotel)
New Delhi—110016.

Education and Training


Scholarships
a. Ministry of welfare: The scheme covers scholarships for general education from class
IX onwards and for technical training at certificate, diploma and degree levels.
Separate provision for reader’s allowance for the blind is also available.
b. Department of social welfare: State governments also provide scholarships to pursue
education from class I to class VIII.

Programme of Integrated Education


Ministry of Human Resource Development - Department of Education.
The programme of integrated education for placing handicapped children in ordinary
schools provides for special coaching classes by qualified and specially trained teachers for
every type of handicapped child. Assessment at the time of admission and later at regular
intervals was a major feature of this programme.
The central government has taken the responsibility of meeting 100 percent expenditure.

Fellowships
The university grants commission has reserved one percent of the fellowships allocated
to the universities for the disabled persons. In the case of scholars who are visuals disabled.
UGC provides a special grant to cover the appointment of a reader.
102 Community Based Rehabilitation of Persons with Disabilities

In industrial training institutes, state governments have reserved three percent seats
for the handicapped under the craftsmen training programme.
The implementing authorities of the apprenticeship training programme at the centre/
state level have been instructed to identify trades from among the existing 136 trades
designated under the Apprentices Act, 1961 considered suitable for apprenticeship. Training
of the physically handicapped and to place the maximum number of handicapped apprentices
in the establishment concerned so as to achieve the overall target of 3 percent taking all
the establishments in the public and private sectors together.

Employment
Special Employment Exchanges (Ministry of Labour, Administrative Control—State
Governments)
The 22 Special Employment Exchanges provide placement facilities to the physically
handicapped for gainful employment (see list pp109-111).
These exchanges follow selective placement approach through job referral system on
the basis of ability and individualised approach through their family background.
Another function assigned to the special employment officer is escorting the candidates
to the employers for interviews and helping both the employers and handicapped in making
personal and job adjustment thereby achieving full rehabilitation.
Medical boards are attached to these special employment exchanges and nedical
examination of the handicapped person at the time of their appointment is arranged through
these Boards.

Vocational Rehabilitation Centres for the Handicapped (VRCs)—Ministry of Labour


It was experienced that placement efforts for the physically handicapped were not bringing
desired results and there was a need to evaluate the residual capacities of the job-seekers
and provide them some adjustment training before they were submitted to the employer
Vocational rehabilitation centres were set up to bridge this gap in our services. The main
objectives of VRCs are:
Vocational evaluation and adjustment of the physically handicapped persons:
• Assessment of the medical, psychological and rehabilitation needs. Assisting in
developing rehabilitation plan depending upon the specific needs.
• Provide in-plant training/skilled training (selected VRCs)
• Sponsoring physically handicapped registrant; against notified/identified vacancies.
• Distribution centres for various schemes like scholarships/aids and appliances.
• Referral to financial institutions for funding self employment ventures.
In order to facilitate speedy rehabilitation of the physically handicapped as also to extend
the existing training facilities in the rural areas. Eleven rural rehabilitation extension centres
have been set up under five selected VRCs (Two each under VRCs at Madras, Ludhiana,
Bombay, Calcutta and three under VRC Kanpur). These extension centres locate physically
handicapped persons, render services pertaining to training and employment and extend
facilities for self-employment ventures.
Resources for CBR and Disability Rehabilitation 103

District Rehabilitation Centres (Ministry of Welfare)


All the VRCs are located in major cities in our country. There is a need of reaching the
masses in rural areas. In 1983, a scheme of district rehabilitation centres was conceived
with an idea to provide comprehensive rehabilitation services, within the geographical area
of a district. As a large strength of specialised man-power is used for delivery of services
at a high per capita cost. The DRCs have restructured the present jobs so that the minimum
of specialists are used for delivery of services.
As a pilot project, ten centres have been set up in as many states. These centres aim
at initially, creation of public awareness, prevention, early detection, parent counselling
and physical restoration services. Subsequently, other components like education, vocational
training, employment, guidance and placement services, etc. are being added.

National Awards (Ministry of Welfare)


In order to stimulate the placement of the physically handicapped, the ministry of welfare
initiated in 1969, a scheme of National Awards to:
• Outstanding employer of the physically handicapped
• The efficient handicapped employees
• Outstanding placement officer for the Handicapped

Economic Assistance for Self-Employment


Under the differential rate of interest scheme, physically handicapped persons who are
pursuing a gainful occupation and have income from all sources not exceeding Rs. 3,000
per annum in urban areas or semi-urban areas or Rs. 2,000 per annum in rural areas and
satisfy certain other conditions, can take loans from the Nationalized Banks.
The amount of loans depend upon the particular scheme proposed to be financed. The
normal limit for such loans is Rs. 1,500 for working capital and Rs. 5,000 for term loan.
The rate of interest is 4 percent per annum. The payment can be made within a period
of 5 years.

Reservations
i. One percent vacancies are reserved for each for the blind, the deaf and the
orthopaedically handicapped with an overall ceiling of 35 in group ‘C’ and ‘D’ posts
in central services and in comparable posts in government of the public sector
undertakings. Priority ill is accorded for submission of candidates by employment
exchanges against central government vacancies for group ‘C’ and ‘D’ posts.
ii. Where the candidates belonging to a particular category of handicapped are not available
or where the nature of work does not technically permit the appointment of a particular
category of handicapped persons interest exchange is allowed.
iii. Where a sufficient number of persons belonging to a given category of the physically
handicapped is not available, the unfilled vacancies will be carried over for a period
upto three recruitment years.
104 Community Based Rehabilitation of Persons with Disabilities

iv. It is the responsibility of each and every employing ministry to identify occupations
that can be practiced without impairing efficiency by various types of physically
handicapped persons with or without the use of special equipment.
v. Physically handicapped persons belonging to the scheduled caste/scheduled tribe are
given preference for recruitment to Group ‘C’ and ‘D’ posts in the public sector
undertakings against the reserve quotas for this category.
vi. To ensure that the physically handicapped persons get the posts reserved for them.
One hundred point Roster is prepared and 34th, 67th and 100th vacancies occurring
in a particular recruitment year are reserved for the blind, the deaf and the
orthopaedically handicapped persons.

Concessions/Relaxations
Age:
i. The upper age limit in the case of blind, deaf and orthopaedically handicapped persons
has been relaxed up to 10 velars for the purpose of appointment of group ‘C’ and ‘D’
posts through the employment exchanges.
ii. Physically handicapped persons belonging to the scheduled castes/scheduled tribes are
(allowed another 5 years over and above the age relaxation admissible to them as
scheduled castes/scheduled tribes.
Physical fitness:
i. Physically handicapped persons are not subjected to the usual medical examination by
the appointing authorities but the report of the medical board attached to the special
employment exchanges for the physically handicapped is sufficient for entry into group
‘C’ and ‘D’ of central government services except in railways.
ii. Medical board may recommend one eyed persons for group ‘A’ and ‘B’ civil posts which
do not require stereoscopic vision or perception of depth, if the Board is satisfied that
the person can perform all the functions of the particular job for which he or she is
a candidate and the visual acuity in the functioning eve is upto the specified standard.
Qualifications: Exemptions is allowed from typing qualification for appointment to clerical
posts if they are found otherwise qualified and certified as being unable to type by the
medical board attached to special employment exchange or by a civil surgeon where there
is no such Board.
Others: Various government of India undertakings like Air India, Indian airlines. Public sector
banks have also extended some concessions/relaxations in upper age limit varying from
5 to 10 years and physical fitness for recruitment to clerical and subordinate cadres.

Other Facilities/Concessions
Travel
a. By Railways: Blind person and mentally handicapped travelling by rail are allowed 75
percent concession in both first and second classes. Wherever they travel along with
Resources for CBR and Disability Rehabilitation 105

an escort both the blind and the escort are allowed 75 percent concession in both first
and second classes.
b. By Roadways: Many of the State Governments offer either full concession or 50 percent
concession for travelling in state run buses. Such facilities are known to have been offered
by Andhra Pradesh, Bihar, Delhi, Goa, Gujarat, Haryana, Himachal Pradesh, Jammu &
Kashmir, Karnataka, Kerala, Maharashtra, Punjab, Tamil Nadu, Tripura, West Bengal
and Uttar Pradesh.
c. By Air: Indian airline allows 50 percent concessional fare to blind persons of single
journey or single fare for round trip journer on all domestic fights. However, escorts
have to pay full fare.
d. Reservation of dealers/agencies of oil companies (Ministry of Petroleum, Chemicals Fertilizers): The
Ministry has decided to earmark 15 percent of all types of dealerships/agencies of the
public sector oil companies for the handicapped persons, including those disabled in war.

Income Tax Concessions


Government of India allows for all categories of physically and mentally handicapped a
deduction of Rs. 15,000 from total income of the parents when computing the net income
for income tax purposes under section 80 DD of the Income Tax Act. Parents can get a
further deductions of Rs. 20,000 from income of the amount is in approved schemes of the
LIC and UTI for the benefit of their disabled off-spring under section 80 U of the Act,
from his/her total income.

Custom Duty
a. Institutions: Institutions for the blind are permitted to import equipment and apparatus
required for education and training of the blind, free of custom duty, if such equipment
and apparatus are received as bona fide gifts. For this purpose, institutions, concerned
are required to obtain a custom clearance permit from chief controller of Imports and
Exports, New Delhi.
b. Individuals: The Central Government exempts certain goods when imported by a blind
person for his personal use from whole of the duty of customs and the additional duty
subject to the condition that the importer produces to the Assistant controller of customs,
as the time of importation, a certificate from the competent authority that the importer
suffers from a particular disability and the imported goods in respect of which the
exemption is claimed are essential to overcome the said disability.
c. Import of audio cassettes from libraries/agencies: Books and magazines recorded on a audio
cassettes are exempted from customs duty when imported from libraries/agencies for
the blind overseas.
d. Preference in housing (Ministry of Works and Housing): Government of India considers the
requests of the blind employees who are eligible for general poor accommodation on
merit. DDA has reserved 5 percent shops. One percent residential plots and 1 percent
flats in each housing scheme for the disabled persons. Many State Governments also
provide out of the turn/reserve some quota of housing accommodation.
106 Community Based Rehabilitation of Persons with Disabilities

e. Supply of petrol/Diesel on Subsidy (Ministry of Welfare): Physically Handicapped owners of


motorised vehicles have been granted exemption from the payment of road tax by the
State Governments/Union Territory Administrations. They are eligible to claim refund
of upto 50 percent of the expenditure incurred by them on purchase of petrol/diesel
from recognized dealers subject to ceiling as indicated below:
Vehicle upto 2 HP -15 its per month
Vehicle upto 2 HP - 25 its per month
The scheme is operative through district social welfare officers or tehsiIdar/equivalent
officer.
f. Pension and unemployment allowance: Some of the (state governments have introduced
disability pension/unemployment allowance schemes. Under these schemes assistance
from Rs. 30 to Rs. 100 per month is paid to the handicapped.
g. Incentive for marriages between blind and nonblind: Andhra Pradesh government had
introduced as incentive of Rs. 300 for the purpose
h. Promotion of voluntary effort for the welfare of the disabled: Realising that the gigantic problem
of rehabilitating the disabled by government alone, both the ministry of welfare,
government of India and the central social welfare board, Delhi have a scheme each
for promoting voluntary efforts. Department of social welfare/welfare of the handicapped
of some of the state governments also provide financial assistance to NGOs for
organizing preventive, early detection and treatment services, special schools, vocational
training centres, physiotherapy, occupational therapy, counselling, medical rehabilitation
including surgical intervention, training of rehabilitation workers, awareness creation
among schools, local self-government authorities. Primary health centres, hospitals,
teachers, parents, local leaders, employers, college students and youth.

The Ministry of Welfare has Two Major Schemes—


a. Recurring and non-recurring grants-in-aid to voluntary organisations upto 90 percent
of the NGOs budget (in case of rural NGO, upto 95 percent of its budget) for providing
services, holding sports meets, seminars, purchase of equipment, for construction of
building, establishment of special school.
b. Grants are given to NGOs who in turn assist needy disabled persons. Aids and appliances
consisting Rs. 25 to Rs. 3,600 are given free to those whose monthly income is below
Rs. 1,200 p.m. at 50 percent cost to those whose monthly income is between Rs. 120
and Rs. 2,500 under this scheme. In 1992-93, nearly Rs. 9.60 crore were given to more
than 302 NGOs benefiting about 43,000 disabled persons.

Cooperative Sector
Cooperative societies formed by disabled enjoy a variety of concessions ranging from
income-tax to permit to receive institutional quota of newsprint, essential commodities, in
sales-tax, excise duty and octroi. The state departments of social welfare/welfare of the
disabled are authorised to contribute subsidy and loan for purchase of shares in the
cooperative societies. Ultimately, the collector, the district school welfare officer, the deputy
Resources for CBR and Disability Rehabilitation 107

registrar of cooperatives and the subdivisional commissioners are the final authorities to
provide exemptions.

General
Using discretionary powers, the collectors can issue institutional ration card, permission
to levy only commercial rate of electricity, cut down/implify red tape and recommend NGOs
proposal for government grants. Issue income/orphan certificates, permission to use river
sand and other local building material and other useful permits.

Resource Institutions—Government
The New Act —Persons with Disabilities Act, 1995 envisages a number of initiatives at the
central and state levels. It can be expected that there will be greater support opportunities
in future.
In addition, a number of national and international organisations (e.g. ActionAid, 3,
Rest House Road. P.B. No. 5406. Bangalore- 560 001) support work with disabled persons.
1. National Institute for the Mentally Handicapped
Manovikas Nagar, Secunderabad 500 009, Andhra Pradesh
Thakur Ilari Prasad Institute, Dilsukh Nagar, Hyderabad 500 660, Andhara Pradesh
2. The Director
National Institute for the Orthopaedically Handicapped
B.T. Road. Bon-Hooghly Calcutta 700 090.
3. The Director
National Institute for the Visually Handicapped
116 Rajpur Road, Dehradun 248 001. Uttranchal
4. All Yavar Jung National lnstitute forthe Hearing
Handicapped, Bandra (West), Mumbai 400 050
5. National Handicapped Welfare Fund
C/o Ministry of Welfare, Govt. of India. Shastri Bhavan, New Delhi 110001
6. The Director
All India Institute of Physical Medicine
Haji Ali, Mumbai 4000 034.
7. The Director
Advanced Orthopaedic Centre
178 Anoop Nagar. Indore 452 008.
8. Institute for Mentally Handicapped
Bal Bhavan, Golghar Complex, Patna 800 001, Bihar.
9. Rehabilitation Council of India
New Delhi
10. The Director Handicapped Welfare Wing, Ministry of Welfare, Govt. of India, Shastri
Bhavan, New Delhi 110 001
11. The Director State Dept. of Social Welfare/Welfare of Handicapped Capital City
108 Community Based Rehabilitation of Persons with Disabilities

NGOs
1. Manovikas Kendra Purb Sarania, Guwahati 781 001, Assam
2. Mental Retardation Project Under UNICEF, Punjab University, Chandigarh 160 014.
3. The Director, Amar Seva Sangam Ayikudi 627 852 Tirunelveli’ District. Tamil Nadu.
4. The Director, Rayalaseema Selva Samithi 2-2-375A K.V. Layout Tirupathi 517 507, Andhra
Pradesh
5. The Director, Society for the Education of the Crippled Agripada Municipal School
Building Motlihai St, Agripada, Mumbai 400 011.
6. Spastic Society in Allahabad, Bangalore, Mumbai, Delhi, Guwahati, Madras and other
cities.
7. Sri Hiralal Sharma, Ashagram Nimar, Barwani District, Madhya Pradesh
8. The Executive Director, National Association of the Blind, 11 Khan Abdul Gaffar Khan
Road, Mumbai 400 025.
9. All India Confederation of the Blind, Braille Bhavan, Institutional Area, Sector 5, Rohini,
New Delhi 110085
10. The Director
National Federation of the Blind, 2322 Laxmi Narayan Street, Paharganj, New Delhi
110 055
11. The Director
Blind Men’s Association, Dr.Vikram Sarabhai Road, Vastrapur, Ahmedabad 380 015
12. The Director, The Blind Boys Academy, Narendrapur. Dist. Twenty-four Paraganas,
West Bengal 721211.
13. The Director, Kerala Federation of the Blind, Kannukuziuy, Trivandram 695037
14. Amar Jyoti Charitable Trust
Karkar Dooma. Vikas Marg., New Delhi 110 092
15. Samadhan
J-32, South Ext.I, New Delhi 110 049
16. Naval Public School
Vasco da Gama, Goa 403 801
17. B.M. Institute of Mental Health, Ashram Road, Ahmedabad 380 009, Gujarat
18. ADMH Centre for Special-Children
Gotri Road, Baroda 390 007
19. Red Cross Institute for Mental Retarded Children
Gandhi Camp, Rohtak 124 001, Haryana
20. Prem Ashram Children’s Home
Una 174 303, Himachal Pradesh
21. Spastic Society of India
Indira Nagar, Bangalore 560 038
22. Asha Kendram, Model Normalisation Centre for
MR Children, Kerikkamurrv, Cochin 682 001, Kerala
23. Asha Niketan Rehabilitation Pradesh Centre
Arera Colony, Bhopal 462 016, Madhya Pradesh
Resources for CBR and Disability Rehabilitation 109

24. Training and Rehabilitation Institute for M.R. 123,


Saifee Nagar, Indore 452 001, Madhya Pradesh
25. Research Society for Children in Need of Special Care
Sewn Hill, Mumbai 400 033, Maharashtra
26. Spastic Society of India
Bandra Reclamation, Mumbai 400 050, Maharashtra
27. Kamayani Vidya Mandir
Cokhale Nagar, Pune 411 053, Maharashtra
28. Chetna Centre for Education of M.R. Children, Lalit Kala Pitha,
Bhubaneshwar 751 009, Orissa
29. Home for Mental Health Vaithikuppam
Pondicherry 605 012
30. Navjivini School for Special Education
53 E, New Police Colony, Patiala 147 001, Punjab
31. Indian Council of Social Welfare
Moti Dungri Road, Jaipur 302004, Rajasthan
32. Navajvothi Trust
A-916 Poonamallee High Road, Chennai 600 084
Tamil Nadu
33. Spastics Society of India
6, Rajamabal Street, I. Nagar, Chennai 600 017
34. Tripura Welfare Society
Banamalipur, Agartala 799 001, Tripura
35. Raphael. Ryder-Cheshire
International Centre, Dehradun 248 001, Uttranchal
36. Institute of Child Health
11 Dr. Biresh Guha Street, Calcutta 700 017, West Bengal
37. Spastic Society of Eastern
India. P-35/1 Taratolla Road, Calcutta 700 088 (West Bengal)
38. Anand Training Centre for
MR Children, Mariam Nagar, Gaziabad 201 003

List of Special Employment Exchanges


1. The Employment Officer
Special Employment Exchange for Physically, Handicapped
33, Mount Abu, Nandnam,
Chennai - 600 035
2. The Employment Officer
Special Employment Exchange for Physically, Handicapped
Agartala (Tripura)
3. The Employment Officer
Special Employment Exchange for Physically, Handicapped Jaipur-302 001 (Rajasthan).
110 Community Based Rehabilitation of Persons with Disabilities

4. The Employment Officer, Special Employment Exchange for Physically, Handicapped,


1282, Sector - 18 C, Chandigarh - 160 015
5. The Employment Officer
Special Employment Exchange for Physically, Handicapped, Patna (Bihar) Combined
Labour Building, Bailey Road. Patna - 800 001.
6. The Employment Officer
Special Employment Exchange for Physically, Handicapped, Guwahati (Assam)
7. The Employment Officer
Special Employment Exchange for Physically, Handicapped, Directorate of Employment
and Training, Flat No. 367, Bhubaneshwar (Orissa)
8. The Employment Officer
Special Employment Exchange for Physically Handicapped, Directorate of Employment
and Training, Stock Palace, Shimla -171 002
9. The Employment Officer
Special Employment Exchange for Physically Handicapped, Barrack No. 1/B-5.
Block—A, Curzon Road, New Delhi - 110 001
10. The Employment Officer, Special Employment Exchange for Physically Handicapped,
5, Council House Street, Ground Floor, Calcutta - 700 001
11. The Employment Officer
Special Employment Exchange for Physically Handicapped, Nandavanam Road,
Palayam, Trivandrum-695 001 (Kerala)
12. The Employment Officer
Special Employment Exchange for Physically Handicapped, Corporation Building,
Marhatal, Jabalpur-482 001 (M.P.)
13. The Employment Officer
Special Employment Exchange for Physically Handicapped, Mercantile Chambers,
3rd Floor, Graham Road, Ballard Estate, Mumbai - 410 001.
14. The Employment Officer
Special Employment Exchange for Physically Handicapped, 1282, Sector 18-C,
Chandigarh - 160 018
15. The Employment Officer
Special Employment Exchange for Physically Handicapped, Corporation Building,
Block-111, Giji Road, Ludhiana.
16. The Employment Officer
Special Employment Exchange for Physically Handicapped, Rajkot.
17. The Employment Officer
Special Employment Exchange for Physically Handicapped, Surat
18. The Employment Officer, Special Employment Exchange for Physically Handicapped,
Salajose Cross Road, Opp. S.V.College, Ahmedabad - 380 001.
19. The Employment Officer
Special Employment Exchange for Physically Handicapped, G.T. Road, Kanpur
Resources for CBR and Disability Rehabilitation 111

20. The Employment Officer


Special Employment Exchange for Physically Handicapped, Azamabad,
Hyderabad - 500 020
21. The Employment Officer
Special Employment Exchange for Physically Handicapped, Baroda.
22. The Employment Officer
Special Employment Exchange for Physically Handicapped,
Vishakapatnam (Andhra Pradesh)

List of Vocational Rehabilitation Centres


1. The Superintendent
Vocational Rehabilitation Centre for Handicapped,
4-Sa-23, Jawahar Nagar, Jaipur-4
2. The Superintendent
Vocational Rehabilitation Centre for Handicapped, 22, Hosur Road, Bangalore
3. The Superintendent
Vocational Rehabilitation Centre for Handicapped, A.T.I. Campus. Udyog Bhavan,
Kanpur.
4. The Superintendent
Vocational Rehabilitation Centre for Handicapped, C.T.I. Campus. Guindy, Chennai.
5. The Superintendent
Vocational Rehabilitation Centre for Handicapped, A.T.I. Campus. Gill Road,
Ludhiana.
6. The Superintendent
Vocational Rehabilitation Centre for Handicapped, Gopi Nath Nagar,
Guwahati-781 016.
7. The Superintendent
Vocational Rehabilitation Centre for Handicapped, A.T.I. Campus. Kuber Nagar,
Ahmedabad - 382 430.
8. The Superintendent
Vocational Rehabilitation Centre for Handicapped, S.T.C.D. Campus, Unit-VIII,
Bhubaneshwar—751 012.
9. The Superintendent
Vocational Rehabilitation Centre for Handicapped, Napier Town, Near Motor Stand,
Opp. Nav Bharat Press, Jabalpur - 482 001
10. The Superintendent
Vocational Rehabilitation Centre for Handicapped, Nalenchira, Trivandrum-15
11. The Superintendent
Vocational Rehabilitation Centre for Handicapped, I.T.I. Campus, Pusa,
New Delhi - 110 012.
12. The Superintendent
Vocational Rehabilitation Centre for Handicapped, Sion - Trombay Road,
Sion, Bombay - 400 022.
112 Community Based Rehabilitation of Persons with Disabilities

13. The Superintendent


Vocational Rehabilitation Centre for Handicapped, 38. Badan Roy Lane, Beliaghata –
15, Calcutta - 700 010
14. The Superintendent
Vocational Rehabilitation Centre for Handicapped, A.T.I. Campus. Vidya Nagar,
Hyderabad - 500 768
15. The Superintendent
Vocational Rehabilitation Centre for Handicapped, C/o. The Director of Employment
and Manpower Planning, Agartala (Tripura)
16. The Superintendent
Vocational Rehabilitation Centre for Handicapped, C/o. Sub-Regional Employment
Exchange for the handicapped, Kothi Building. First Floor (Women only), Vadodara
- 390 001 (Gujarat).
17. The Superintendent
Vocational Rehabilitation Centre for Handicapped, C/o. Director of Employment and
Training, Patna
18. The Superintendent
Vocational Rehabilitation Centre for Handicapped, Sitamarhi (Bihar)

List of District Rehabilitation Centres


1. The Project Officer
Rehabilitation Centre, 290, Begum Bagh, Sitapur—261 001, Uttar Pradesh.
2. District Rehabilitation Officer
District Rehabilitation Centre, Devalai Pada, Kharodi Naka, Bolinj, Virar (West), Vasai,
District Thane, Maharashtra
3. District Rehabilitation Officer
District Rehabilitation Centre Chengalpattu, Tamil Nadu
4. District Rehabilitation Officer
District Rehabilitation Centre, Kharagpur General Hospital, P.O. Kharagpur. District
Midnapur, West Bengal
5. District Rehabilitation Officer
District Rehabilitation Centre, No. 549, Adarsha, 95, Main Road, Sidhartha Layout,
Mysore - 560 011.
6. District Rehabilitation Officer
District Rehabilitation Centre, Orthopaedic and Physic Therapy Unit, Bhubaneshwar
Orissa
7. District Rehabilitation Officer
District Rehabilitation Centre, Kota, Rajasthan
8. District Rehabilitation Officer
District Rehabilitation Centre, House No. 32-15-102.4. Bhanu Apartment, Near
Madhu Garden, Mogalarajapuram, Vijaywada - 520 010, Andhra Pradesh
9. District Rehabilitation Officer
District Rehabilitation Centre, Bhiwani, SCO, 68-70, Sector 17-A, Chandigarh 160 017.
Resources for CBR and Disability Rehabilitation 113

10. District Rehabilitation Officer


District Rehabilitation Centre, Jagadishpur, Uttar Pradesh
11. District Rehabilitation Officer
District Rehabilitation Centre, Bilaspur, Madhya Pradesh

Legislations
1. Rehabilitation Council of India Act, 1992.
2. The persons with Disability (Security and Rehabilitation) Act, 1996.
3. The Rehabilitation Council of India Act, 1992 for regulating the training of rehabilitation
professionals and the maintenance of a Central Rehabilitation Register has come into
effect from 31.7.1993.
4. The Mental Health Act, 1987.

References
1. Ali Baquer, Disabled Disablement Disablism: Voluntary Health Association of India,
New Delhi, 1994.
2. Bhushan Punani & Nandini Rawal, Hand Book: Vishal Handicap: Ashish Publishing
House, New Delhi –1993.
3. Braille and talking Book Catalouges published in the region.
4. Camp Approach for Rehabilitation of Polio Patients in Rural Areas: Proceedings of the
WHO Seminar held at Lall India Institute of Medical Sciences, Edited by Dr. S.K. Verma,
Dr. U. Singh & Dr. D.K. Taneja, New Delhi 27-28 January, 1991.
5. Community Rehabilitation Programme. A NIMH, Secunderabad publication.
6. David Wener, Disabled Village Children: A guide for community health workers,
rehabilitation workers and families: Voluntary Health Association of India, New Delhi,
1994.
7. Directory of Professionals in Mentally Handicapped in India. A NIMH, Secunderabad
Publication, 1992.
8. Educational Concessions for the Blind, National Association for the Blind, 1991.
9. GOI, Encyclopaedia of Social Work in India: New Delhi, 1987.
10. Indian Guide to Aids and Appliances for the Blind, National Association for the Blind,
1992.
11. Job-analysis and Qn the Job Training for Persons with Mental Retarded-Series. A NIMH,
Secunderabad Publication.
12. Mallick, P.K. Management Training in Total Rehabilitation of Tibarewala, D.N the
Disabled: Calcutta: National Institute for the Orthopaedically Handicapped, 1990.
13. Mane, P. Mental Health in India: Gandevia. KY (ed) Mumbai: TISS, 1993.
14. Mental Retardation, A Manual for Village Rehabilitation Workers. A NIMH,
Secunderabad publication.
15. Organization of Special School for Mentally Retarded Persons. A NIMH, Secunderabad
publication.
16. Programmes and Concessions for the Blind. All India Confederation of the Blind. 1990
114 Community Based Rehabilitation of Persons with Disabilities

17. R.S. Pandey and Lal Advani. Perspectives Perspecives in Disability and Rehabilitation:
Vikas Publishing House Pvt. Ltd., New Delhi, 1995.
18. Webb, J.B. “Society’s Role in Rehabilitation”. Calcutta: Rehabilitation Centre for
Children, 1990.

List of Aids and Equipment for the Disabled


a. Blind Contact: The Director, National Institute for the Visually Handicapped, 116 Rajpur
Road, Dehradun, 248001, Uttaranchal.
1. Braille writers and Braille Writing Equipment
2. Handwriting equipment. Braille Frames. Slatesm, Writing Guides. Styli. Braille
Erasers, Script Writing Guides.
3. Canes, Electronic aids like the Sonic Guide.
4. Optical, Environmental sensors.
5. Arithmetic aids like Taylor Frame (Arithmetic and Algebra Types), Cybarythm,
speaking of Braille Calculators.
6. Geometrical aids like combined graph and mathematical demonstration board, Braille
protractors, scales, compasses and spare wheels.
7. Electronics measuring equipment, such as calipers, micrometers, comparators, gauges,
gauge block levels, rulers and yard sticks.
8. Drafting drawing aids, tactile displays.
9. Specially adapted clocks and watches.
b. Artificial Limbs Manufacturing Corpn.
(ALIMCO) of India, G.T. Road, Kanpur, U.P.
c. Hearing Handicapped
All Yavar Jung National Institute for the Hearing Handicapped, Bandra (West), Mumbai
400 050.
d. Mentally Handicapped
National Institute for the Mentally Handicapped, Manovikas Nagar, Secunderabad
500 009.

Bilateral /Multilateral Agencies

UNESCO – United Nations Educational, Scientific and Cultural Organisation


http://www.unesco.org/education/educprog/sne

UN – United Nations
http://www.un.org/esa/socdev/enable

United Nations Special Rapporteur for the Commission for Social Development on Disability
Email : un-spec.rapp@telia.com
UNICEF – United Natins Children Fund
http://www.unicef.org
WHO – World Health Organisation
http://www.who.int/hpr/rhb/index.html
Resources for CBR and Disability Rehabilitation 115

International NGOs

ADD, UK - Action on Disability and Development


http:// www.add.org.uk
CBM – Christoffel Blinden Mission
http://www.christoffel-blindenmission.de
HI – Handicap International
http://- www.handicap-international.org
Japanese Society for Rehabilitation of Persons with Disabilities
http://www.jsrd.or.jp/index-e@hotmail
LCI - Leonard Cheshire International
http://www.leonardcheshire.org
Oxfam
http://www.oxfam.org.uk

Disabled Peoples Organisations (DPOs)

Disabled Peoples International


http://dpi.org
Disabled People’s Association Singapore
Http://www.dpa.org
SHIA
http://www.shia.se/englishshia.htm

Useful Websites

Heperian Foundation
http://www.hesperian.org
Asia Pacific Disability Rehabilitation Journal
http://www.aifo.it/english/apdrj/apdrj.htm
World Vision
http://wvision.org
World Blind Union
http://www.wbuga.org
Rehabilitation International
http://www.rehab.international.org
Inclusion International
http://www.inclusion-international.org
World Federation of the Deaf
http://www.wed.news.org
The International Dyslexia Association
http://www.interdys.org/index.jsp
www.censusindia.net/disability/disability—map gallery html
116 Community Based Rehabilitation of Persons with Disabilities

ASSIGNMENT FOR TRAINEES


Preparation for seminars—suggested topics:
a. Principles of community-based rehabilitation
b. Monitoring and Supervision of community-based rehabilitation
c. Evaluation of community-based rehabilitation programmes
d. Decadal Targets
e. Accessibility and mobility
f. Legislative approach to rehabilitation

BIBLIOGRAPHY
1. ADD India, Building Abilities Books for Change (Publishers) Bangalore, 2001.
2. AHRATAG—Resources in community-based Rehabilitation
3. DAR Unit, WHO, Geneva, list of publications
4. Disability and liberation—OXFAM—Peter Coleridge
5. Disabled village children by David Werner—Hesperian Foundation
6. Harsh Mander Agenda For Caring VHAI, New Delhi, 2000.
10 Legislations
DISABILITY ACT OF 1995 AND OTHER LEGISLATIONS CONCERNING DISABLED
PEOPLE IN INDIA
Excerpts from Disability Act: Status of Implementation; need for advocacy—advocacy at
Individual, Family and Community level; organising disabled people; organising self help
groups, organising parent’s groups;
Other legislations—National Trust Act, Mental Health Act; Indian Factories Act; ESI Act;
Mines Labourer’s Act, Dock Labourer’s Act, etc.

LEARNING OBJECTIVES
• Participants should be able to list provisions under Disability Act of 1995.
• Participants should be able to list important provisions under National Trust Act,
National Mental Health Act, The ESI Act, The Indian Factories Act
• Participants should be able to comprehend the meaning and approaches to advocacy
measures—individual, group, state and country levels.

OUTLINE OF CONTENT
• Details of history of legislations for the disabled, upto UN standard rules
• Details of Disability Act of 1995; machinery for implementation; status of implementation
• Census and Disabled people
• Details of National Trust Act, National Mental Health Act, The ESI Act, The Indian
Factories Act.

SUGGESTED METHODOLOGY
• Lecture—discussion
• Focus group discussion with disabled people

PRE/POST EVALUATION
• What is advocacy?
• What are the contents of UN Standard rules/Disability Act of 1995
118 Community Based Rehabilitation of Persons with Disabilities

THE INDIAN FACTORIES ACT, 1948


The Indian Factories Act dates back to 1881 and latest revision was in 1987. Few important
provision of relevance in this context include:
The Act prescribes in detail the precautions which should be taken for ensuring the safety
of workers. Some of the precautions relate to casing of machinery, devices for cutting off
the power, hoists and lifts cranes and other lifting devices, protecting of the eyes and
precautions against dangerous fumes, explosive and inflammable material.
The Act provides that no worker shall be required to lift or carry loads which are likely
to cause injury. The state governments are empowered to prescribe maximum weights which
may be lifted or carried by men, women and children.
Elaborate provisions have been made regarding health, safety and welfare measures.
Provisions include restriction for employment of young persons, specifications for hours
of work, leave with wages, occupational disease notification (including accidents which cause
death, bodily injury), enquiry in every case of fatal accident, safety and occupational health
suveys in factories and industries.
Special provisions regarding employment in hazardous occupations have also been made.

THE EMPLOYEES STATE INSURANCE ACT, 1948


The ESI Act passed in 1948 (amended in 1975, 1984 and 1989) is an important measure of
social security in India. It provides for certain cash and medical benefits to industrial
employees in case of sickness, maternity and employment injury. Provisions include medical
benefit, sickness benefit, maternity benefit, disablement benefit, funeral expenses and
rehabilitation.
Rehabilitation benefit includes: on payment of Rs. 10 per month, the insured person and
family members continue to get medical treatment after permanent disablement, retirement.
Disablement benefit includes free medical treatment, cash payment, in the event of
temporary/permanent disablement following employment injury/occupational diseases.
The rate of temporary disablement is 72 percent of wages as long as disablement lasts.
In case of permanent disablement, the insured person will be given life pension at full rate,
i.e. 72 percent of wages.
Apart from medical treatment, dentures, spectacles, and hearing aids are provided free
to patients who are incapacitated due to employment injury. Artificial limbs are provided
free to insured persons who loose their limbs in employment injury or otherwise. Special
appliances like hernia belts, walking calpers, surgical boots, pinal braces and jackets are
provided as prescribed by specialists.
Of course, both The Indian Factories Act and The ESI Act refer to employees of organized
sectors only as both employee and employer contribute to the scheme.

DISABILITY ACT OF 1995 AND OBSTACLES TO IMPLEMENTING


THE DISABILITY ACT
Though disabled persons number about 45 million in the country today, only recently have
their needs been recognised and legislated on in the persons with Disabilities Act, 1995.
Legislations 119

In this chapter, the salient features of the Act, the implementation mechanisms, the
magnitude of the problem in India, and the international consensus on the need to redress
the problems of the disabled are dealt with.

The Act and its Promulgation


The persons with Disabilities (equal opportunities protection of rights and full participation)
Act, 1995 received the assent of the President of India on 1st January 1996 and notification
to this effect was made on 7th February 1996. The Act seeks to fix responsibilities on the
central and state governments to the extent of available resources, to provide services, create
facilities and give support to people with disabilities in order to enable them to have equal
opportunities in participating as productive citizens of this country to the fullest extent of
their abilities. The legislation is an important landmark in the history of the disability
movement in the country.
For drafting and revision of the persons with Disabilities Act, the ministry of welfare,
government of India launched a wide process of consultation with hundreds of NGOs
working with the gamut of disabled people across the country. All state governments
participated in the process of formulation of the Bill.
It may be recalled that India is a signatory to the proclamation on the full participation
and equality of people with disabilities in the Asia and Pacific region. The proclamation
is at the instance of the United Nations (UNESCAP) and many NGOs. The Act is a sequel
to the proclamation and is aimed at enabling and protecting the rights of the disabled,
whereas, the Mental Health Act of 1987 is a service-oriented legislation.

Salient Features of the Act


The Act, despite a few shortcomings, is unique and aims at improving the quality of life
of persons with disability. It promises a barrier-free environment facilitating access to
buildings, roads and travel. It promised both children and adults disability prevention
activities, access to education, medical care, vocational training, job opportunities, social
security measures, etc.
The Act seeks to fix responsibilities or the Central and State Governments to the extent
of available resources, to provide services, create facilities and give support to people with
disabilities in order to enable them to have equal opportunities in participating as productive
citizens of this country to the fullest extent of their abilities. The legislation is an important
landmark in the history of the disability movement in the country.
Clauses 44 to 46 of the Indian Act include provisions for different features of the physical
environment such as the transport sector (all rail compartments, buses vessels, aircraft,
including hotels and waiting rooms) roads (auditory signals, kerb cuts, slopes, zebra
crossing, railway platforms, symbols and warning signals); the built environment (ramps
in public buildings toilets, adaptations to wheelchair users, Braille symbols and auditory
signals in lifts and ramps in hospitals, health centres and other medical care and
rehabilitation institutions). The Indian Act defines persons with disability as “a person
suffering from not less than 40 percent of any disability as certified by the medical
120 Community Based Rehabilitation of Persons with Disabilities

examination” of particular significance in the Persons with Disabilities Act in India is the
inclusion of leprosy-cured persons. For people affected by leprosy, mention of them as
separate category represents a triumph for leprosy workers who have in recent years
increasingly advocated for this group to be officially included as a disability group to
facilitate their social and economic rehabilitation as distinct from medical treatment.
The separation of groups who had earlier been treated as belonging to a single category
is also of significance. For example, blind and low vision persons (earlier not distinguished
as being two groups with different needs and abilities); as well as persons with mental
retardation and those with mental illness (earlier treated as being of the same category
of persons with mental disorders).
Since the last two and a half years, we see two major developments. Firstly, there has
been an attempt at the centre and in the states to appoint co-ordination committees. The
central executive committee was constituted almost one and a half years after enactment
and chief commissioners were appointed only recently. Rules have been framed in
government of India notification dated 31 December 1996 for the implementation of the
Act. The rules specifically focus on:
• Guidelines for evaluation and assessment of various disabilities;
• Central co-ordination committee;
• Central executive committee;
• Employment;
• Chief commissioner of persons with disabilities
Regrettably, the committees are yet to meet on a regular basis, understand the terms
of reference and act upon them which means not much has happened after the Act has
been passed. The pace of implementation of the Act is dismally slow. Full-time
commissioners are yet to be appointed in States, and the representation of NGOs and
disabled persons is grossly inadequate both at the centre and the states. In a nutshell, one
can say there is no difference in the quality of life of persons with disability since the
enactment.
Important functions are assigned to the central and state co-ordination committees
though they do not seem to have accomplished much since their formation. Their functions
include:
• Serving as a national/state focal point on disability matters;
• Reviewing and co-ordinating activities of all Government departments, Governmental
Organisations (GOs) and Non-Governmental Organisations (NGOs);
• Developing national policy to address issues faced by disabled persons;
• Advising central government on the formulation of polices, programmes, legislation and
projects with respect to disability;
• Taking steps to ensure a barrier-free environment in public places, work places, public
utilities, schools and other institutions;
• Monitoring and evaluating the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities.
Legislations 121

MAGNITUDE OF THE PROBLEM OF DISABILITY IN INDIA


In India today there are approximately 45 million persons with disability. Locomotor
disability constitutes the major type, and hardly 3 to 5 percent of those in need are being
reached by the government and NGO efforts community-based rehabilitation (CBR) has
been attempted by many organisations like DRC scheme, the Government of India, ADD
India Seva in Action, Christoffel Blinden Mission, UNICEF, many national and international
NGOs including ActionAid India but the end practice needs large-scale geographical
expansion. Persons with disabilities continue to be marginalised deprived of basic minimum
needs. Opportunities an access to information and services. The quality of life of PWD in
India is such that there are hardly any attempts towards equalisation of opportunities and
reducing social discrimination. This applies to all forms of disabilities. Prevention
programmes have made a minimal impact; much needs to be done to augment activities
in the following areas:
• Prevention programmes: primary immunisation; vitamin A; prophylaxis; ICDS scheme;
ante-natal, post-natal and intra-natal care; and care of children under-five;
• Developing manpower for disability rehabilitation, especially community-based
rehabilitation (CBR) establishing human resources development centres;
• Evolving comprehensive policy for PWD and national community-based rehabilitation
plans;
• Strengthening upgradation of technology and manufacture of aids and appliances on
a large scale;
• Creating barrier-free access to all places, public and private;
• Co-ordination with NGOs and other partners working in the area of disability
rehabilitation.

International Consensus
The International Labour Organisation (ILO), UNESCO and WHO have given a joint
statement endorsing community based rehabilitation as the key approach towards improving
the quality of life of PWD. UNESCAP has established regional interagency committee for
the Asia and Pacific to address disability related concerns. The world programme of action,
declaration of Asian and Pacific decade of disabled persons, the decade’s mandate and
targets for action are important developments towards growing international concern and
consensus towards full participation of disabled persons. We see improved technology and
service delivery mechanisms in Japan and Hong Kong with the intensive involvement of
both government and voluntary sectors.
The Seoul declaration (1997) and the Hong Kong statement (1998) during the conference
of rehabilitation international, campaigns of the regional NGO Network, UNESCAP review
(1997) are important attempts towards international co-operation and consensus.

Will the Disability Act Make a Difference?


Yes, it will, provided it is fully implemented in spirit and action. The People with Disability
Act of 1995 promises a barrier free environment, access to education, medical facilities and
122 Community Based Rehabilitation of Persons with Disabilities

employment of all persons with disabilities within the limits of the resources. The Act
highlights coordination of NGO and governmental efforts.
Evolution of a comprehensive policy, development of a national CBR plan, human
resources development in CBR, creating a barrier-free environment will make a great deal
of difference to the quality of life of a PWD. There is a need to arrive at detailed rules,
detailed plans and strategies and appropriate budget allocation.
NGOs have been major players in rehabilitation in India. Networking and information
exchange among NGOs, government, and private sector will make a lot of difference in
the implementation of the provisions of the Act. There is a need for understanding of the
Act, collaboration for the ownership, and responsibility for the implementation of the Act
by both government and NGOs. Involvement of corporate sector will definitely contribute
towards improving the quality of life of PWD in our country.
Rehabilitation of persons with disability is cost-intensive and corporate sector
involvement is likely to make a difference. Attempts have been made by ActionAid India
to widen the horizon of choices for PWD through corporate partnerships. These attempts
are either towards programme development (CBR programme) or towards increasing
employment opportunities in the private sector. Collaboration with Titan watches is an
example towards this end.
The Disability Act of 1995 leaves the enforcement of respective provisions to courts of
law without prescribing special summary procedures to be followed in the event of
proceeding under the respective legislation. This makes it difficult for persons with
disabilities, who usually have limited resources and legal knowledge, to participate in
complicated, lengthy and expensive legal processes.
There is need for concerted efforts to be made on information dissemination and raising
public awareness concerning equalization legislation. Public awareness programmes on
various provisions are required which aim at generating understanding among both disabled
and non-disabled citizens in diverse sectors. Such programmes are also needed where there
is general ignorance of the rights of citizens with disabilities. Developing mechanisms and
criteria for regular monitoring, periodic evaluation and strengthening of equalization
legislation using the feedback obtained are needed. The absence of adequate mechanisms,
and criteria for monitoring and evaluation, particularly if compounded by a lack of resource
allocation, means that well drafted legislation with excellent provisions may languish.

Suggestions for a Plan of Action


Some suggestions for a plan of action for the next two years are as follows:
• Ensuring formation of co-ordination committees in all states;
• Developing targets for national-level and state-level implementation;
• Formation of national and state-level action groups;
• Translation and wide distribution of the agenda for Action and Disability Act, 1995;
• Conduct of workshops at various levels - regional, state, district, mandal;
• Campaigns at national, district, taluk levels;
Legislations 123

• Orientation programmes on the Disability Act of 1995 for panchayat members,


employers, NGOs, disabled people’s organisations, general public;
• Formulation of rules at national and state-levels for the implementation of the Disability
Act;
• Updating technology for the manufacture of aids and appliances and its fair distribution;
• Initiating a national CBR programme and development of appropriate logistics for the
same such as training, aids and appliances, research, etc.;
• Including details of the Disability Act as part of the curriculum of middle schools and
secondary schools;
• Including aspects of disability rehabilitation and community based rehabilitation in the
curriculum of doctors, nurses, teachers, IAS officers, civil engineers and architects;
• Preparation and distribution in all Indian languages of summary books, posters, flip
charts and materials for mass media on the Act;
• Supporting co-ordination committees at national and state levels towards speedy and
effective implementation of the People with Disability Act of 1995.
The Disability Act of 1995 is framed following the directions and content of UN standard
rules. Other important legislations related to persons with Disability include The Mental
Health Act of 1937 and The National Trust Act.

The National Trust Act


The National Trust Act is an important piece of welfare legislation in the country. This
legislation aims to provide residential care/responsibility by the government to make
provisions for care for persons with mental retardation, cerebral palsy, autism, multiple
disabilities. This relatively new legislation is yet to see the light of implementation in the
country.

Organisational Case Study VI

About…. Action on Disability and Development India

VISION, POLICY AND BELIEF


ADD India’s vision is of a world where all disabled people are able to participate as fully as they choose,
at every level in the society.
ADD India aims to promote self-help and integration of persons with disabilities in the communities
in which they are living. ADD India believes that all people have the same fundamental rights to
determine their future and to participate in decision-making processes that affect their life. These include
the right to:
• Adequate food and clean water
• A home and family relationships
• Respect and influence
• Safety from harm and abuse
• Health care and education
• A livelihood
• Mobility and accessibility
• Recreation and social relations.
Contd...
124 Community Based Rehabilitation of Persons with Disabilities
Contd...
ADD pays particular attention to the situations of disabled women and children. They are among the
poorest and most discriminated and deprived people in society.
ADD views disability as a social creation – an expression of society’s attitude to impairment. It is society,
which must change to ensure full inclusion of disabled people in all aspects of life.

APPROACH
ADD works in partnership with local organizations in rural south India. It supports them through training,
review and planning of their work.

ADD’s work with partners includes:


Policy Development: Developing a policy and programme to work with the disabled in their area of
work.
Training of staff and field workers of partners in all aspects of disability awareness, field work analysis,
case study, group work techniques, basic rehabilitation skills, counseling, communication and media
skills, and programme management.
Development of systems for implementation and monitoring of programme.
Accessing Services: Assisting partners in liaising with governmental and non-governmental
organizations in the areas of medical rehabilitation, education and vocational training.
Communication : Techniques to raising awareness among the public and in communities on disability
issues.
Support Role: Supporting partners to establish services for medical rehabilitation.

ADD India’s direct involvement:


ADD also runs three direct projects in the states of Karnataka, Andhra Pradesh and Tamil Nadu, In
these projects, besides enabling disabled people to get rehabilitation services, they are encouraged
to form self-help groups (Sanghas) through a process of creating awareness and confidence building.

Contact Details:
Mr. R. Ramachandran
Executive Director
Action On Disability and Development India
4005. 18th Cross, Banashankari II Stage, Bangalore-560 070
Email: addindia@vsnl.net

ASSIGNMENT FOR TRAINEES


1. Preparation of a review paper on legislations for disabled persons in our country
2. Interactions with commissioner of disabilities of the state
3. Review of selected case studies

BIBLIOGRAPHY
1. Call for Action (ActonAid India, CAPART and NCPEDP).
2. Case Study of effort by Javed Abidi to include disability Question in Census 2001.
3. Government of India, The Persons With Disabilities (Equal Opportunities, Protection of Rights and Full
Participation) Act, 1995, New Delhi, 1995.
4. Model building Rules
5. The ESI Act
Legislations 125

6. The Indian Factories Act


7. The Mental Health Act
8. The National Trust Act
9. United Nations, Asian and Pacific Decade of Disabled Persons, 1993-2002: Mandates for Action, UN, 1994.
10. United Nations, Legislation on Equal Opportunities and Full Participation in Development for Disabled Persons:
Examples from the ESCAP Region, 1997.
11. United Nations, Legislation on Equal Opportunities and Full Participation in Development for Disabled Persons;
A Regional Review, 1995.
Vocational Training
and Employment of
11 Persons with Disability
LEARNING OBJECTIVES
At the end of this session, participants must be able to list needs of persons with disability,
identify vocational opportunities, employment opportunities in the neighbourhood of their
college/residential area, field practice area; organize vocational counseling camps; list
institutions/employers with whom networking and alliance will help facilitate persons with
disability independent.

OUTLINE OF CONTENT
• What is vocational rehabilitation?
• What is vocational assessment?
• Employment for disabled people
• How to plan vocational training and employment opportunities for persons with
disabilities?

SUGGESTED METHODOLOGY FOR THE FACULTY


• Lecture-discussion—3 hours
• Visit to vocational training centers meant for both persons with disabilities and able-
bodied persons
• Talking to persons with disabilities engaged in employment/not engaged in employment
• Observing counseling sessions.

PRE/POST EVALUATION
• List needs of persons with disability
• List jobs which persons with different disabilities may not be able to do.
• List jobs persons with disabilities will not be able to do
• List vocational training and employment opportunities for persons with disabilities

INTRODUCTION
It is useful recall couple of incidents and experiences while beginning to discuss about
vocational training and employment opportunities for persons with disabilities. I was doing
Vocational Training and Employment of Persons with Disability 127

a survey of persons with disabilities in Cholaimedu slums in Chennai, South India. A middle-
aged lady came and asked me what are you doing here. I explained to her that a disability
survey is being done in the area where persons with disabilities will be listed, their needs
are assessed and appropriate interventions for Medical, Educational and Vocational needs
can be better planned. She had Congenital Talipes Equino Varus Deformity in both limbs.
Looking at her I suggested to her Surgery will make her feet better. She told me—I do
not want surgery. Can you give me a Buffaloe? I can live happily.
I was working as a Medical Officer in a rural area of Kolar District in Karnataka, India—
I found persons with Mental Retardation working as Shepherds, persons with severe
hearing impairment doing masonry work, farming, animal husbandry, all kinds of hard
labor.
Mr. Ramudu, who has severe degree of visual impairment—worked as a community-
based rehabilitation worker in Sourabha community-based rehabilitation Project now runs
a STD booth and has opened a small scale Industry. A lady who is totally blind in a village
use to help the family by lifting 40 buckets of water from a well. Many persons with disability
do self-employment. Javed Abidi who is on wheelchair organized persons with disabilities
across the country in India. He heads National Council for Employment of Persons with
Disabilities in New Delhi, India.
Mr. Prasanna Kumar Pincha, Joint Director of Social Welfare, Government of Assam is
a well-known efficient officer in North-East of India. Mr. Pincha has visual disability.
In a leading public sector company in India, which is highly responsive to the
communities, a large number of people with Hearing Impairment work in Electronic circuit
assembly. It is in Bharath Electronics located in Bangalore, India. Similar picture is observed
in a separate unit supported by Titan watches in Hosur near Bangalore, India.
The combined and coordinated medical, social, educational and vocational measures for
training and retraining an individual to the highest possible level of functional ability are
called rehabilitation.
Restoration of function constitutes medical rehabilitation, restoration of personal dignity
and confidence is focused in psychological rehabilitation; restoration of family and social
relationships constitutes social rehabilitation.
Restoration of capacity to earn a livelihood constitutes Vocational Rehabilitation. Let
us try to examine this issue in depth in this chapter.
Rehabilitation is not extracurricular activity of a doctor/physiotherapist. A
physiotherapists’ job does not end if therapy has helped gaining a particular movement
better/normal. One needs to train/retrain persons with disability “to live and work within
the limits of disability to the hilt of his capacity”.

What is Vocational Rehabilitation?


Vocational rehabilitation or placement in a suitable job matching with the abilities of an
individual and one that provides the individual concerned with an income sufficient to
maintain himself/herself with dignity is the ultimate goal of most adults of working age.
Economic independence is what every one looks for whether he/she is able bodied/
disabled. Desire and need is stronger in persons with disability.
128 Community Based Rehabilitation of Persons with Disabilities

Today, in India—because of increased urbanization, breakup of joint family system,


stresses and strains of urban life makes all weaker sections of the society finding difficult
to be economically independent. Almost they will be in the edge of survival. Persons with
disabilities are no exclusion to this. Both capacity and opportunity is necessary to achieve
economic independence. While social security measures may help persons with disabilities
in richer countries, in developing countries, though social security measures are there, total
security to make oneself economically independent is not possible over couple of decades
in future in developing countries.
Hence there is a need for vocational training and employment for persons with
disabilities. The challenge in developing countries like India is to do this in the context
of poverty, more than 45 million persons with disability, underemployment and no
employment already prevailing. Persons with disabilities need to compete with able-bodied
persons to achieve economic independence.

What is Vocational Assessment?


When the person with disability is returning to employment after the onset of disability
or if the person has not worked earlier, there is a need to assess aptitude/abilities/work
capacity of the person to help him seek a job. Essentially, vocational assessment involves
following steps:
Step I: Standardized tests to assess intelligence, interests, manual dexterity, mechanical and
other aptitudes.
Step II: Practical tests to assess the individual’s performance in a variety of jobs—ability
to concentrate, work speed, ability to lift weights,
Alternatively, assessment may be done while the person with disability is working in
a production center or sheltered employment center. Combination of both methods will
give comprehensive picture. Team of rehabilitation professionals—placement officer,
psychologist, occupational therapist need to do the assessment.
It is frequently assumed that persons with disabilities cannot or do not want to work.
Given the opportunity, can do work and want to work. They want and need to work
because they want to earn livelihood, enjoy social contacts and gain self-esteem. Earning
a livelihood helps them to become economically independent, reduce burden on the family
and misery and despair will disappear. Having a job increases social contact, avoids isolation
and reduces frustration and loneliness.

Skills Training
Skills training are traditionally provided for persons with disabilities in special training
centers. Vocational Rehabilitation centers of Government of India are located all over the
country, many centers run by NGOs also help in skill training. Skill training helps disabled
people compete with able-bodied persons in seeking job. In the vocational training center
for the handicapped in Bangalore, a number of trades have been identified, manuals and
methodology for skill training is developed. Examples of this include book binding, screen
Vocational Training and Employment of Persons with Disability 129

printing, electrician training, mechanic training, plumbing, carpentry, kitchen utensil making,
etc.
In Sourabha community-based rehabilitation project of Sri Ramana Maharishi Academy
for the Blind and Sri Thirumurthy Rural Development Centre near Kanakapura in Bangalore
Rural District, vocational training is offered in areas of animal husbandry, sericulture,
horticulture, farming, poultry keeping, silk weaving, cardboard box making, etc.
A public sector Bank in India—Canara Bank has established vocational training centers
where training will be provided on trades relevant to local communities.
There is a need for rural rehabilitation and rural integration programmes with focus
on rural trades in our country keeping in mind need for addressing 70 percent of the
population of the State.

Promoting Job Seeking Skills


It is important that persons with disabilities need to help themselves by meeting prospective
employers. While this can be facilitated in urban areas for educated persons with disability,
by Newspaper, Employment Exchanges, Email, Fax, TV, etc. but promoting this among rural
disabled is a challenge. This is possible only by mouth-to-mouth information, local
newspapers and local Government/NGOs taking interest to start an employment exchange
unit. Government of India has established special Employment Exchanges and many NGOs
like Mithrajyothi in Bangalore and Arushi in Bhopal have private employment exchanges
too. Appropriate jobs relevant to the areas is important. That is why there is a need to
focus on jobs keeping literacy, poverty, and agrarian infrastructure in mind, in India
especially.

Production Units
Apprenticeship and working in production units will help make vocational assessment as
well as will help person with disability to compete with able bodied.

Work Trials
Employment exchanges and placement service agencies can plan to provide these
opportunities to both employees and employers. This mechanism has not developed much
in our country.
Job provides self-confidence and dignity. Work builds positive attitudes.

Problems that Persons with Disabilities Face for Seeking Jobs


Work is central to well being of persons with disabilities. But, they will find it difficult
to find as well as retain jobs. This may be because of both disability as well as attitude
of neighbours, community and family members.
Barriers that exclude persons with disabilities from employment related services and
opportunities are social, economic, cultural and political. All are real, but can be overcome.
The obstacles they face include negative attitudes often linked to discrimination, unequal
access to education and training, inaccessible buildings, lack of accessible information,
130 Community Based Rehabilitation of Persons with Disabilities

inaccessible transport, lack of assertive devices and support services, low self esteem and
overprotective families, lack of supportive legal environment and lack of policy support.
Lack of education, lack of employable skills, rapidly changing labor markets, employer’s
attitudes and perceptions, lack of access to self-employment opportunities, unfair terms of
employment, higher work related costs and special problems for disabled women and girls
are barriers to employment.
Although persons with disabilities may be unable to do certain things, with willingness
and innovation, the obstacles to meaningful employment are surmountable.

Women with Disabilities


Although opportunities for women in education and employment are improving, and their
attitudes for education and training are more positive, but little has changed for women
with disabilities. Job opportunities for disabled women continue to be less.
Disabled women face triple discrimination because of poverty, gender and disability.
Overall women with disabilities receive less pay than disabled men and less pay than non-
disabled women.
Because of their vulnerability, they may face greater possibilities of sexual harassment
than other women.

Self-employment for Persons with Disabilities


One of the common opportunities which persons with disabilities appear to be successful
is self-employment. Many NGOs have tried this in our country and variety ranges from
petty shop, sheep rearing to gem cutting unit. Very information to such opportunities is
lacking. This, added with educational level is a barrier to seek help and guidance from
local Bank. Often, the project fails because of lack of a viable proposal for self-employment.
In one of the villages of South India, Ramadevi, who became totally blind because of
retinitis pigmentosa, was sitting at home without any productive occupation. She was
provided information about mobility training, loan schemes for persons with disability and
how to seek a medical certificate certifying her disability status. She was facilitated to have
a medical certificate. She was introduces to local bank manager also. She underwent mobility
training and she can walk independently—she can prepare rice and prepare coffee. After
mobility training, people leave her alone in the house.
She has not been able yet to develop a viable proposal for self-employment. Loan is
available. On interacting with family in depth, it was found that her husband is a teacher,
earning very less money in a nearby private school and wants to do business taking loan
in her name rather than allowing Ramadevi to do independently and support her. This
is what woman with disabilities face in developing countries. The CBR staff is working
with the family to address this issue.
Plenty of opportunities exist for persons with disabilities to pursue self-employment.
What is needed is information and access to loan, development of a business plan and
training in entrepreneurship, support till the employment is established. All public sector
Banks in India have loan facilities for persons with disabilities. Loan amount ranges from
small amounts to large amounts like Rs.50,000 for women with disabilities (Mahila Udyogini
Vocational Training and Employment of Persons with Disability 131

Scheme of Government of India). Interest rate under some of these schemes is also nominal.
Bottleneck is in accessing it.
Self-employment offers unlimited hope and scope. If groups of persons with disabilities
are formed in all villages/slums, opportunities for loans for self-employment are plenty.
This is often not utilized since organization of persons with disabilities, families of persons
with disabilities is still a concept in most of the villages.

Open Employment for Persons with Disabilities


Vocational assessment, skill development, information and access can help open employment
for persons with disabilities. Under the Disability Act of 1995, in India, 3 percent of
Government jobs are reserved for persons with disabilities. Some state like Karnataka have
taken lead in making it 5 percent. Issue is—are they filled? Unless proactive measures are
taken to identify employment situations, vocational assessment is made, directory of
employees is kept, and it will not be possible to ensure employment for persons with
disabilities. Special employment exchanges and Employment exchanges run by NGOs are
making an attempt in this direction.
With 45 million persons with disabilities in India, job availability in Government sector/
private sector will meet some need only.

Sheltered Employment
In many countries in developing countries, persons with disabilities have opportunities to
work under sheltered environments and are provided boarding, lodging and wages are
subsidized, production norms are kept low. Such opportunities are present in developing
countries only in pockets and are limited to provision of food, clothing, shelter and pocket
money rather than wages.
Few parents and parents’ associations have taken lead in establishing sheltered
employment opportunities in India. If a group of persons with disabilities plan to establish
a production unit, there is scope and opportunity for large amounts of financial support
from Handicapped Welfare Association of States. Often, this is not utilized. It is unfortunate
that only 5 percent of persons with disabilities have utilized facilities or have access to
Government schemes.
Note from the ILO publication “Integrating women and girls with disabilities into
mainstream vocational training—A practical guide” is interesting. It says:
“Traditionally, programmes for persons with disabilities were segregated. If they had
opportunities, they are available in special schools, residential institutions, and vocational
training programmes and even in work places. While such programmes can play a vital
role for severely disabled people, there is serious limitations in vocational training, this
approach.
Segregates people with disabilities and the rest of the society from each other,
perpetuating the problem of isolation for disabled people and lack of awareness for the
rest of the society.
Tends to maintain disability and sex stereotyped training activities, which are often low
paying jobs, such as dress making, hair dressing, basketry, handicrafts, typing and shorthand
132 Community Based Rehabilitation of Persons with Disabilities

(for women), and carpentry, radio-repair, car-repair and electrical work (for men). Can
only address a tiny fraction of the training needs”.

ASSIGNMENT FOR STUDENTS


• Visit a village in the field practice area, talk to communities and list what persons with
disabilities are doing with respect to vocational training and employment.
• Visit a slum in the field practice area, talk to communities and list what persons with
disabilities are doing with respect to vocational training and employment.
• Write in detail in practical record—visit reports of following institutions;
1. Vocational Rehabilitation Centres in Government/Private set up in the neighbourhood
of the College
2. Agro-based vocational rehabilitation centers
3. NTTF/IIT/Industries
4. Sheltered Employment areas.

BIBLIOGRAPHY
1. Barbara Murray and Robert Herson (1999) “Job Placement of Job Seekers with Disabilities—Elements of an
effective service “, ILO, Bangkok.
2. Cheyutha 1998-2000, “Empowerment of Persons with Disabilities”, Government of Andhra Pradesh, India.
3. Einar Helander “Prejudice and Dignity” United Nation Development Programme.
4. Foo Galk Sim (1999) “Integrating Women and Girls with disabilities into mainstream.
5. Government of India “The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full
Participation) Act 1995 with Rules 1997”, Law Publishers India Ltd. Allahabad, India.
6. Robert Herson and Barbara Murray (1997) “Assisting Disabled Persons in Finding Employment “ A Practical
Guide, ILO, Bangkok.
7. Suresh C Ahuja “ Vocational Rehabilitation of the disabled” ActionAid Disability News Vol. 9, No. 2, 1998.
8. Vocational Training—A Practical Guide ILO, Bangkok.
Role of Physiotherapists
in Community-based
Rehabilitation of
12 Persons with Disabilities
India lives in villages. There are 6 lakh villages spread across 600 revenue districts in the
country. Each District in India has a population of about 1 to 2 million. About 74 persent
of population lives in rural areas.
About 6 percent live in tribal belt villages. It is estimated that more than 45 million
persons with disabilities are there in India. In urban areas too, one-third of the population
lives in slums. That means there is need to address rehabilitation issues among the poor,
less literate and in areas where transportation facilities are very poor and rehabilitation
manpower is scarce. In this situation, there is need to:
• Take measures to prevent disabilities
• Transfer skill to communities to develop their own rehabilitation programmes
• Ensure utilization of local resources
• Focus efforts on persons with disabilities, families and communities.

ROLE OF A PHYSIOTHERAPIST
Doctors, Physiotherapists, Special Educators have a major role to play in this direction. There
is need to demystify skills so that it should be possible for family member/person with
disability/community member to act as a therapist/doctor/special educator. Hence, the
author visualizes the role of Physiotherapist in a developing country like India as follows:
• Should be able to develop knowledge, attitudes and skills among students to respond
to poverty/literacy/poor rehabilitation resource availability in the communities.
• Should be a counselor to disabled people/their families and communities.
• Should be able to effectively address the medical needs of people with locomotor
disabilities, cerebral palsy and appropriately refer and guide the person with disability
to meet his educational, vocational and social needs.
• Should be able to refer to relevant personnel for addressing needs of persons with other
disabilities too—communication disabilities, mental retardation, and visual disabilities.
• Should be able to identify resources required for people with all disabilities, educational
and vocational opportunities, as coverage is an important area in community-based
rehabilitation. In essence, physiotherapist can be a coordinator of rehabilitation services
wherever he/she is working—rather than an isolated therapist addressing therapy needs.
134 Community Based Rehabilitation of Persons with Disabilities

He/She needs to be a manager. In a country like India where population is large and
rehabilitation manpower is scarce irrespective of his primary role as a Physiotherapist,
Special Educator, Doctor, one needs to be a Rehabilitation manager.

COMMUNITY-BASED REHABILITATION IS A APPROACH, NOT A SCHEME FOR


IMPLEMENTING REHABILITATION
Community-based rehabilitation is an approach to rehabilitation and not a scheme of
rehabilitation. It encompasses participation of disabled people, families and communities
at all levels—planning, implementation and evaluation. The approach can be better taught
if a field practice area is developed in every Physiotherapy College and hands on
opportunities are given to students of physiotherapy to work with persons with disabilities
in the communities they live in.

LINKAGES AND ALLIANCES FOR COMMUNITY-BASED REHABILITATION


The student of physiotherapy can respond to community’s rehabilitation needs in future
only if he is able to develop liaison, linkages and alliance with individuals, organizations
working for persons with disabilities. As a manager of rehabilitation, following linkages
will be useful for him/her:
• Parents’ groups, organizations of persons with disabilities in the area
• Medical Officer and Health Workers namely Jr. Health Assistant (F), Sr. Health Assistant
(F) and Health Educator of Local Primary Health Centre/Urban Family Welfare Centre.
• Child Development Project Officer and Anganawadi supervisors and Anganawadi
workers of the area.
• Staff of special schools located nearby
• Specialists of ENT, Ophthalmology, Orthopedics, Psychiatry, Clinical Psychology,
Psychiatry
• Teachers of Nursery, Primary and Secondary Schools
• District Disability Officer, Social Welfare Officer, Officer of Women and Child Welfare
• Nearby Mental Hospital
• Nearby business centers, vocational training, special education and orthotic and prosthetic
centers
• Zilla Panchayat and Taluk Panchayat Committees, Revenue and Block Development
officers, Education Officers
• Lions Club, Rotary Club, Giants, NGOs working in the locality
• Public sector Banks
• Community based groups like Women’s groups (Sthree Shakthi), Farmer’s Associations,
Youth groups, etc.

ATTRIBUTES OF A REHABILITATION MANAGER


There is a need to understand customs, traditions, culture of communities before carving
a community-based rehabilitation programme. Following attributes will help him develop
skills of rehabilitation manager:
Role of Physiotherapists in CBR of Persons with Disabilities 135

• Physiotherapy skills
• Counseling skills
• Communication skills
• Skills of motivation
• Local language
• Knowledge of local resources
• Skills of networking with Government/Private/NGO organizations
• Skills of quantitative and qualitative research like Participatory Research
• Advocacy skills
• Knowledge of Government welfare schemes for persons with disability

BIBLIOGRAPHY
1. ADD India. “Building Abilities”.
2. David Werner. “Disabled Village Children”,Publication of Healthwrights.
3. David Werner. “Nothing About Us Without Us”. Publication of Healthwrights.
4. Einar Helander. “Prejudice and Dignity” UNDP, New York.
5. Harsh Mander and Vidya Rao. “An agenda for Caring”. Publication of Voluntary Health
Association of India.
6. Maya Thomas and Pruthvish S. “Identification and needs Assessment of Persons with
Disabilities in Community Based/Rehabilitation Initiatives”—Monograph published by
ActionAid India.
7. Peter Coleridge. “Disability, Liberation and Development”. Publication of OXFAM.
8. UNICEF Disability Kit, UNICEF, Nepal.
9. WHO Training in the community for people with disabilities, WHO, Geneva.
Annexures
ANNEXURE I

THE PERSONS WITH DISABILITIES


(EQUAL OPPORTUNITIES, PROTECTION OF RIGHTS
AND FULL PARTICIPATION) ACT, 1995.

PRELIMINARY
1. 1. This Act may be called the Persons with Disabilities (Equal Opportunities, Protection
of Rights and Full Participation) Act, 1995.
2. It extends to the whole of India except the State of Jammu and Kashmir.
3. It shall come into force on such date as the Central Government may, by notification,
appoint.
2. In this Act, unless the context otherwise requires -
a. “Appropriate Government” means –
i. In relation to the Central Government or any establishment/wholly or substantially
financed by that Government, or a Cantonment Board constituted under the
Cantonment Act, 1924, the Central Government;
ii. In relation to a State Government or any establishment wholly or substantially
financed by that Government, or any local authority other than a Cantonment
Board, the State Government;
iii. In respect of the Central Coordination Committee and the Central Executive
Committee, the Central Government;
iv. In respect of the State Coordination Committee and the State Executive Committee,
the State Government;
b. “Blindness” refers to a condition where a person suffers from any of the following
conditions, namely:-
i. total absence of sight; or
ii. visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting
lenses; or
iii. limitation of the field of vision subtending an angle of 20 degree or worse;
c. “Central Coordination Committee” means the Central Coordination Committee
constituted under sub-section (1) of section 3;
d. Central Executive Committee” means the Central Executive Committee constituted
under sub-section (1) of section 9;
e. “Cerebral palsy” means a group of non-progressive conditions of a person characterised
by abnormal motor control posture resulting from brain insult or injuries occurring
in the pre-natal, peri-natal or infant period of development;
138 Community Based Rehabilitation of Persons with Disabilities

f. “Chief Commissioner” means the Chief Commissioner appointed under sub-section


(1) of section 57;
g. “Commissioner” means the Commissioner appointed under sub-section (1) of section
60;
h. “Competent authority” means the authority appointed under section 50;
i. “Disability” means
• Blindness;
• Low vision;
• Leprosy - cured;
• Hearing impairment;
• Locomotor disability;
• Mental retardation;
• Mental illness;
j. “Employer” means,—
i. In relation to a Government, the authority notified by the Head of the Department
in this behalf or where no such authority is notified, the Head of the Department;
and
ii. In relation to an establishment, the Chief Executive Officer of that establishment;
k. “Establishment” means a corporation established by or under a Central, Provincial
or State Act, or an authority or a body owned or controlled or aided by the Government
or a local authority or a Government company as defined in section 617 of the
Companies Act, 1956 and includes Departments of a Government;
l. “Hearing impairment” means loss of sixty decibels or more in the better ear in the
conversational range of frequencies;
m. “Institution for persons with disabilities” means an institution for the reception, care,
protection, education, training, rehabilitation or any other service of persons with
disabilities;
n. “Leprosy cured person” means any person who has been cured of leprosy but is
suffering from—
i. Loss of sensation in hands or feet as well as loss of sensation and paresis in the
eye and eye-lid but with no manifest deformity;
ii. Manifest deformity and paresis but having sufficient mobility in their hands and
feet to enable them to engage in normal economic activity;
iii. Extreme physical deformity as well as advanced age which prevents him from
undertaking any gainful occupation, and the expression “Leprosy Cured” shall
be construed accordingly;
o. “Locomotor disability” means disability of the bones, joints or muscles leading to
substantial restriction of the movement of the limbs or any form of cerebral palsy;
p. “Medical authority” means any hospital or institution specified for the purposes of
this Act by notification by the appropriate Government;
q. “Mental illness” means any mental disorder other than mental retardation;
r. “Mental retardation” means a condition of arrested or incomplete development of
mind of a person which is specially characterized by subnormality of intelligence;
Annexures 139

s. “Notification” means a notification published in the Official Gazette;


t. “Person with disability” means a person suffering from not less than forty percent
of any disability as certified by a medical authority;
u. “Person with low vision” means a person with impairment of visual functioning even
after treatment of standard refractive correction but who uses or is potentially capable
of using vision for the planning or execution of a task with appropriate assertive
device;
v. “Prescribed” means prescribed by rules made under this Act;
w. “Rehabilitation” refers to a process aimed at enabling persons with disability to reach
and maintain their optimal physical, sensory, intellectual, psychiatric or social functional
levels;
x. “Special Employment Exchange” means any office or place established and maintained
by the Government for the collection and furnishing of information, with by keeping
of registers or otherwise, respecting —
i. Persons who seek to engage employees from amongst the persons suffering from
disabilities;
ii. Persons with disability who seek employment;
iii. Vacancies to which person with disability seeking employment may be appointed;
y. “State Coordination Committee” means the State Coordination committee constituted
under sub-section (1) of section 13;
z. “State Executive Committee” means the State Executive Committee constituted under
sub-section (1) of section 19.
140 Community Based Rehabilitation of Persons with Disabilities

THE CENTRAL COORDINATION COMMITTEE

1. The Central Government shall by notification constitute a body to be known the Central
Coordination Committee to exercise the powers conferred on, and to perform the functions
assigned to it, under this Act.
2. The Central Coordination Committee shall consist of
a. The Minister in charge of the Department of Welfare in the Central Government
Chairperson, ex-officio,
b. The Minister of State in-Charge of the Department of Welfare in the Central
Government, Vice-Chairperson, ex-officio’,
c. Secretaries to the Government of India in-charge of the Department of Welfare,
Education, Woman and Child Development, Expenditure, Personnel, Training and
Public Grievances, Health, Rural Development, Industrial Development, Urban Affair
and Employment, Science and Technology, Legal Affairs, Public Enterprises, Members
ex-officio’,
d. Chief Commissioner, Member, ex-officio’,
e. Chairman Railway Board, Member, ex-officio,
f. Director - General of Labour, Employment and Training, Member, ex-officio,
g. Director, National Council for Educational Research and Training, Member ex-officio’,
h. Three Members of Parliament, of whom two shall be elected by the House of the
People and one by the Council of States, Members;
i. Three persons to be nominated by the Central Government to represent, the ii which
in the opinion of that Government ought to be represented. Members;
j. Directors of the—
i. National Institute for the Visually Handicapped, Dehradun;
ii. National Institute for the Mentally Handicapped, Secundrabad.
iii. National Institute for the Orthopedically Handicapped, Calcutta.
iv. Ali Yawar Jung National Institute for the Hearing Handicapped, Mumbai; Members,
ex-officio’,
k. Four Members to be nominated by the Central Government by rotation to represent
the States and the Union Territories in such manner as may be prescribed by the
Central Government;
Provided that no appointment under this clause shall be made except on the
recommendation of the State Government or, as the case may be, the Union Territory;
l. Five persons as far as practicable, being persons with disabilities, to represent non-
governmental organisations or associations which are concerned with disabilities, to
be nominated by the Central Government, one from each area of disability, Members;
Provided that while nominating persons under this clause, the Central Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
m. Joint Secretary to the Government of India in the Ministry of Welfare dealing with
the welfare of the handicapped, Member, Secretary, ex-officio,
Annexures 141

3. The office of the Member of the Central Coordination Committee shall not disqualify
its holder for being chosen as or for being a Member of either House of Parliament.
4. a. Save as otherwise provided by or under this Act a Member of Central Coordination
Committee nominated under clause (i) or clause (1) of sub-section (2) of section 3
shall hold office for a term of three years from the date of his nomination:
Provided that such a Member shall, notwithstanding the expiration of his term,
continue to hold office until his successor enters upon his office.
b. The term of office of an ex-officio Member shall come to an end as soon as he ceases
to hold the office by virtue of which he was so nominated.
c. The Central Government may if it thinks fit remove any Member nominated under
clause (i) or clause (1) of sub-section (2) of section 3, before the expiry of his term
of office after giving him a reasonable opportunity of showing cause against the same.
d. A Member nominated under clause (i) or clause (1) of sub-section (2) of section 3
may at any time resign his office by writing under his hand, addressed to the Central
Government and the seat of the said Member shall thereupon become vacant.
e. A casual vacancy in the Central Coordination Committee shall be filled by a fresh
nomination and the person nominated to fill the vacancy shall hold office only for
the remainder of the term for which the Member in whose place he was so nominated.
f. A member nominated under clause (i) or clause (1) of sub-section (2) of section 3
shall be eligible for renomination.
g. Members nominated under clause (i) and clause (1) of sub-section (2) of section 3
shall receive such allowances as may be prescribed by the Central Government.
5. No person shall be a Member of the Central Coordination Committee, who
a. Is, or at any time has been, adjudged insolvent or has suspended payment of his
debts or has compounded with his creditors, or
b. Is of unsound mind and stands so declared by a competent court, or
c. Is or has been convicted of an offence which, in the opinion of the Central Government,
involves moral turpitude, or
d. Is or at any time has been convicted of an offence under this Act, or
e. Has so abused in the opinion of the Central Government his position as a Member
as to render his continuance in the Central Coordination Committee detrimental to
the interests of the general public.
f. No order of removal shall be made by the Central Government under this section
unless the Member concerned has been given a reasonable opportunity of showing
cause against the same.
g. Notwithstanding anything contained in sub-section (1) or sub-section (6) of section
4, a Member who has been removed under this section shall not be, eligible for
renomination as a Member.
6. If a Member of the Central Coordination Committee becomes subject to any of the
disqualifications specified in section 5, his seat shall become vacant.
7. The Central Coordination Committee shall meet at least once in every six months and
shall observe such rules of procedure in regard to the transaction of business at its meetings
as may be prescribed by the Central Government.
142 Community Based Rehabilitation of Persons with Disabilities

8. a. Subject to the provisions of this Act, the function of the Central Coordination Committee
shall be to serve as the national focal point on disability matters and facilitate the
continuous evolution of a comprehensive policy towards solving the problems faced
by persons with disabilities.
b. In particular and without prejudice to the generality of the foregoing, the Central
Coordination Committee may perform all or any of the following functions, namely:
i. Review and coordinate the activities of all the Departments of Government and
other Governmental and non-Governmental Organisations which are dealing with
matters relating to persons with disabilities.
ii. Develop a national policy to address issues faced by persons with disabilities:
iii. Advise the Central Government on the formulation of policies, programmes,
legislation and projects with respect to disability;
iv. Take up the cause of persons with disabilities with the concerned authorities and
the international organisations with a view to provide for schemes and projects
for the disabled in the national plans and other programmes and policies evolved
by the international agencies;
v. Review in consultation with the donor agencies their funding policies from the
perspective of their impact on persons with disabilities;
vi. Take such other steps to ensure barrier-free environment in public places, work
places, public utilities, schools and other institutions;
vii. Monitor and evaluate the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities;
viii. To perform such other functions as may be prescribed by the Central Government.
9. 1. The Central Government shall constitute a Committee to be known as the Central
Executive Committee to perform the functions assigned to it under this Act.
2. The Central Executive Committee shall consist of—
i. The Secretary to the Government of India in the Ministry of Welfare, Chairperson,
ex-officio,
ii. The Chief Commissioner, Member, ex-officio,
iii. The Director-General for Health Services, Member, ex-officio,
iv. The Director-General, Employment and Training, Member, ex-officio’,
v. Six persons not below the rank of a Joint Secretary to the Government of India,
to represent the Ministries or Departments of Rural Development, Education,
Welfare, Personnel Public Grievances and Pension, Urban Affairs and Employment,
Science and Technology, Members, ex-officio,
vi. The Financial Advisor, Ministry of Welfare in the Central Government, Member,
ex-officio,
vii. Advisor (Tariff) Railway Board, Member, ex-officio,
viii. Four members to be nominated by the Central Government, by rotation, to represent
the State Governments and the Union Territories in such manner as may be
prescribed by the Central Government;
ix. One person to be nominated by the Central Government to represent the interest,
which in the opinion of the Central Government ought to be represented, Member;
Annexures 143

x. Five persons, as far as practicable, being persons with disabilities, to represent


non-governmental organisation or associations which are concerned with
disabilities, to be nominated by the Central Government, one from each area of
disability, Members.
Provided that while nominating persons under this clause, the Central Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
xi. Joint Secretary to the Government of India in the Ministry of Welfare dealing
with the welfare of the handicapped, Member-Secretary, ex-officio.
c. Members nominated under clause (i) and clause (j) of sub-section (2) shall receive
such allowances as may be prescribed by the Central Government;
d. A Member nominated under clause (i) or clause (j) of sub-section (2) may at any time
resign his office by writing under his hand addressed to the Central Government
and the seat of the said Member shall thereupon become vacant.
10. a. The Central Executive Committee shall be the executive body of the Central
Coordination Committee and shall be responsible for carrying out the decisions of
the Central Coordination Committee,
b. Without prejudice to the provisions of sub-section (1), the Central Executive Committee
shall also perform such other functions as may be delegated to it by the Central
Coordination Committee.
11. The Central Executive Committee shall meet at least once in three months and shall observe
such rules of procedure in regard to the transaction of business at its meetings as may
be prescribed by the Central Government.
12. a. The Central Executive Committee may associate with itself in such manner and for
such purposes as may be prescribed by the Central Government any person whose
assistance or advice it may desire to obtain in performing any of its functions under
this Act.
b. A person associated with the Central Executive Committee under sub-section for any
purpose shall have the right to take part in the discussions of the Central Executive
Committee relevant to that purpose, but shall not have a right to vote at a meeting
of the said Committee, and shall not be member for any other purpose.
c. A person associated with the said Committee under sub-section (7) for any purpose
shall be paid such fees and allowances, for attending its meetings and for attending
to any other work of the said Committee, as may be prescribed by the Central
Government.
144 Community Based Rehabilitation of Persons with Disabilities

THE STATE COORDINATION COMMITTEE

1. a. Every State Government shall, by notification, constitute a body to be known as the


State Coordination Committee to exercise the powers conferred on, and to perform
the function assigned to it, under this Act.
b. The State Coordination Committee shall consist of—
i. The Minister in-charge of the Department of Social Welfare in the State Government,
Chairperson, ex-officio’,
ii. The Minister of State in-charge of the Department of Social Welfare, if any, Vice-
Chairperson, ex-officio’,
iii. Secretaries to the State Government in-charge of the Departments of Welfare,
Education, Woman and Child Development, Expenditure, Personnel Training and
Public Grievances, Health, Rural Development, Industrial Development, Urban
Affairs and Employment, Science and Technology, Public Enterprises, by whatever
name called, Members, ex-officio,
iv. Secretary of any other Department which the State Government considers
necessary, Members, ex-officio’,
v. Chairman Bureau of Public Enterprises (by whatever name called) Member, ex-
officio,
vi. Five persons, as far as practicable, being persons with disabilities, to represent
non-governmental organisations or associations which are concerned with
disabilities, to be nominated by the State Government, one from each area of
disability. Members;
Provided that while nominating persons under this clause, the State Government
shall nominate at least one women and one person belonging to Scheduled Castes
or Scheduled Tribes;
vii. Three Members of State Legislature, of whom two shall be elected by the Legislative
Assembly and one by the Legislative Council, if any;
viii. Three persons to be nominated by that State Government to represent agriculture,
industry or trade or any other interest, which in the opinion of State Government
ought to be represented. Members, ex-officio,
ix. The Commissioner, Member, ex-officio,
x. Secretary to the State Government dealing with the welfare of the handicapped,
Member-Secretary, ex-officio.
c. Notwithstanding anything contained in this section, no State Coordination Committee
shall be constituted for a Union Territory and in relation to a Union Territory, the
Central Coordination Committee shall exercise the functions and perform the functions
of a State Coordination Committee for the Union Territory:
Provided that in relation to a Union Territory, the Central Coordination Committee
may delegate all or any of its powers and functions as under this sub-section to such
person or body of persons as the Central Government may specify.
Annexures 145

2. a. Save as otherwise provided by or under this Act, a Member of a State Coordination


Committee nominated under clause (f) or clause (h) of sub-section (2) of section 13
shall hold office for a term of three years from the date of his nomination:
Provided that such a Member shall, notwithstanding the expiration of his term,
continue to hold office until his successor enters upon his office.
b. The term of office of an ex-officio Member shall come to an end as soon as he ceases
to hold the office by virtue of which he was so nominated.
c. The State Government may, if it thinks fit, remove any Member nominated under
clause (f) or clause (h) of sub-section (2) of section 13 before the expiry of his term
of office after giving him a reasonable opportunity of showing cause against the same.
d. A Member nominated under clause (f) or clause (h) of sub-section (2) of section 13
may at any time, resign his office by writing under his hand addressed to the State
Government and the seat of the said Member shall thereupon become vacant.
e. A casual vacancy in the State Coordination Committee shall be filled by a fresh
nomination and the person nominated to fill the vacancy shall hold office only for
the remainder of the term for which the Member in whose place he was so nominated.
f. A Member nominated under clause (f) and clause (i) of sub-section (2) of section 13
shall be eligible for renomination.
g. Members nominated under clause (0) and clause (h) of sub-section (2) of section 13
shall receive such allowances as may be prescribed by the State Government.
3. a. No person shall be a Member of the State Coordination committee, who—
i. Is, or at any time, has been adjudged insolvent or has suspended payment of
his debts or has compounded with his creditors, or
ii. Is of unsound mind and stands so declared by a competent court, or
iii. Is or has been convicted of an offence which in the opinion of the State Government
involves moral turpitude, or
iv. Is or at any time has been convicted of an offence under this Act, or
v. Has so abused, in the opinion of the State Government, his position as a member
as to render his continuance in the State Coordination Committee detrimental
to the interests of the general public.
b. No order of removal shall be made by the State Government under this section unless
the Member concerned has been given a reasonable opportunity of showing cause
against the same.
c. Notwithstanding anything contained in sub-section (1) or sub-section (6) of section
14, a Member who has been removed under this section shall not be eligible for
renomination as a Member.
4. If a Member of the State Coordination Committee becomes subject to any of the
disqualifications specified in section 15, his seat shall become vacant.
5. The State Coordination Committee shall meet at least once in every six months and shall
observe such rules of procedure in regard to the transaction of business at its meetings
as may be prescribed.
146 Community Based Rehabilitation of Persons with Disabilities

6. a. Subject to the provisions of this Act, the function of the State Coordination Committee
shall be to serve as the state focal point on disability matters and facilitate the continuous
evolution of a comprehensive policy towards solving the problems faced by persons
with disabilities.
b. In particular and without prejudice to the generality of the foregoing function the
State Coordination Committee may, within the State perform all or any of the following
functions, namely:—
i. Review and coordinate the activities of all the Departments of Government and
other Governmental and non-governmental Organisations which are dealing with
matters relating to persons with disabilities;
ii. Develop a State policy to address issues faced by persons with disabilities;
iii. Advise the State Government on the formulation of policies, programmes,
legislation and projects with respect to disability;
iv. Review, in consultation with the donor agencies, their funding policies from the
perspective of their impact on persons with disabilities;
v. Take such other steps to ensure barrier-free environment in public places, work
places, public utilities, schools and other institutions;
Provided that while nominating persons under this clause, the State Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
vi. Monitor and evaluate the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities;
vii. To perform such other functions as may be prescribed by the State Government;
7. a. The State Government shall, constitute a committee to be known as the State Executive
Committee to perform the functions assigned to it under this Act.
b. The State Executive Committee shall consist of—
i. The Secretary, Department of Social Welfare, Chairperson, ex-officio,
ii. The Commissioner, Member, ex-officio,
iii. Nine persons not below the rank of a Joint Secretary to the State Government,
to represent the Departments of Health. Finance, Rural Development, Education,
Welfare,
Personnel Public Grievances, Urban Affairs, Labour and Employment, Science
and Technology, Members ex-officio;
iv. One person to be nominated by the State Government to represent the interest,
which in the opinion of the State Government ought to be represented. Member;
v. Five persons, as far as practicable being persons with disabilities, to represent
non-governmental organisations or associations which are concerned with
disabilities, to be nominated by the State Government, one from each area of
disability. Members;
Provided that while nominating persons under this clause, the State Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
Annexures 147

vi. Joint Secretary dealing with the disability division in the Department of Welfare,
Member-Secretary, ex officio,
c. Members nominated under clause (d) or clause (e) of sub-section (2) shall receive
such allowances as may be prescribed by the State Government.
d. A Member nominated under clause (d) or clause (e) may at any time resign his office
by writing under his hand addressed to the State Government and the seat of the
said Member shall thereupon become vacant.
8. a. The State Executive Committee shall be the executive body of the State Coordination
Committee and shall be responsible for carrying out the decisions of the State
Coordination Committee.
b. Without prejudice to the provisions of sub-section (1) the State Executive Committee
shall also perform such other function as may be delegated to it by the State Coordination
Committee.
9. The State Executive Committee shall meet at least once in three months and shall observe
such rules of procedure in regard to the transaction of business at its meetings as may
be prescribed by the State Government.
10. a. The State Executive Committee may associate with itself in such manner and for such
purposes as may be prescribed by the State Government any person whose assistance
or advice it may desire to obtain in performing any of its functions under this Act.
b. A person associated with the State Executive Committee under sub-section (1) for
any purpose shall have the right to take part in the discussions of the State Executive
Committee relevant to that purpose, but shall not have a right to vote at a meeting
of the said Committee and shall not be a member for any other purpose.
c. A persons associated with the said Committee under sub-section (1) for any purpose
shall he paid such fees and allowances, for attending its meetings and for attending
to any other work of the said Committee, as may be prescribed by the State
Government.
11. In the performance of its functions under this Act.—
a. the Central Coordination Committee shall be bound by such directions in writing,
as the Central Government may give to it; and
b. the State Coordination Committee shall be bound by such directions in writing, as
the Central Coordination Committee or the State Government may give to it:
Provided that where a direction given by the State Government is inconsistent
with any direction given by the Central Coordination Committee, the matter shall
be referred to the Central Government for its decision.
12. No act or proceeding of the Central Coordination Committee, the Central Executive
Committee, a State Coordination Committee or a State Executive Committee shall be
called in question on the ground merely on the existence of any vacancy in or any defect
in the constitution of such Committees:
148 Community Based Rehabilitation of Persons with Disabilities

PREVENTION AND EARLY DETECTION OF DISABILITIES

1. Within the limits of their economic capacity and development, the appropriate
Governments and the local authorities, with a view to preventing the occurrence of
disabilities, shall
a. Undertake or cause to be undertaken surveys, investigations and research concerning
the cause of occurrence of disabilities.
b. Promote various methods of preventing disabilities;
c. Screen all the children at least once in a year for the purpose of identifying “at-risk”
cases:
d. Provide facilities for training to the staff at the primary health centers;
e. Sponsor or cause to be sponsored awareness campaigns and disseminate or cause
to be disseminated information for general hygiene, health and sanitation;
f. Take measures for pre-natal, and post-natal care of mother and child;
g. Educate the public through the pre-schools, schools, primary health centres, village
level workers and anganwadi workers;
h. Create awareness amongst the masses through television, radio and other mass media
on the causes of disabilities and the preventive measures to be adopted.
Annexures 149

EDUCATION

1. The appropriate Governments and the local authorities shall—


a. Ensure that every child with a disability has access to free education in an appropriate
environment till he attains the age of eighteen years;
b. Endeavour to promote the integration of students with disabilities in the normal schools;
c. Promote setting up of special schools in Government and private sector for those
in need of special education, in such a manner that children with disabilities living
in any part of the country have access to such schools;
d. Endeavour to equip the special schools for children with disabilities with vocational
training facilities;
2. The appropriate Governments and the local authorities shall by notification make schemes
for—
a. Conducting part-time classes in respect of children with disabilities who having
completed education up to class fifth and could not continue their studies on a whole-
time basis;
b. Conducting special part-time classes for providing functional literacy for children in
the age group of sixteen and above;
c. Imparting non-formal education by utilizing the available manpower in rural areas
after giving them appropriate orientation;
d. Imparting education through open schools or open universities;
e. Conducting class and discussions through interactive electronic or other media;
f. Providing every child with disability, free of cost special books and equipment needed
for his education.
3. The appropriate Governments shall initiate or cause to be initiated research by official
and non-governmental agencies for the purpose of designing and developing new assistive
devices, teaching aids, special teaching material or such other items as are necessary
to give a child with disability equal opportunities in education.
4. The appropriate Governments shall set up adequate number of teachers’ training
institutions and assist the national institutes and other voluntary organisations to develop
teachers’ training programmes specialising in disabilities so that requisite trained manpower
is available for special schools and integrated schools for children with disabilities.
5. Without prejudice to the foregoing provisions, the appropriate Governments shall by
notification prepare a comprehensive education scheme which shall make provision for—
a. Transport facilities to the children with disabilities or in the alternative financial
incentives to parents to guardians to enable their children with disabilities to attend
schools;
b. The removal of architectural barriers from schools, colleges or other institutions
imparting vocational and professional training;
c. The supply of books, uniforms and other materials to children with disabilities attending
school;
150 Community Based Rehabilitation of Persons with Disabilities

d. The grant of scholarship to students with disabilities;


e. Setting up of appropriate for the redressal of grievances of parents regarding the
placement of their children with disabilities;
f. Suitable modification in the examination system to eliminate purely mathematical
questions for the benefit of blind students and students with low vision;
g. Restructuring of curriculum for the benefit of children with disabilities;
h. Restructuring the curriculum for benefit of students with hearing impairment to
facilitate them to take only one language as part of their curriculum.
6. All educational institutions shall provide or cause to be provide amanuensis to blind
students and students with or low vision.
Annexures 151

EMPLOYMENT

1. Appropriate Governments shall


a. Identify posts in the establishments which can be reserved for the persons with
disability;
b. At periodical intervals not exceeding three years, review the list of posts identified
and up-date the list taking into consideration the developments in technology.
2. Every appropriate Government shall appoint in every establishment such percentage of
vacancies not less than three percent for persons or class of persons with disability of
which one percent each shall be reserved for persons suffering from—
• blindness or low vision;
• hearing impairment;
• locomotor disability or cerebral palsy, in the posts identified for each disability.
Provided, that the appropriate Government may, having regard to the type of work
carried on in any department or establishment, by notification subject to such conditions,
if any, as may be specified in such notification, exempt any establishment from the
provisions of this section.
3. a. The appropriate Government may, by notification, require that from such date as
may be specified, by notification, the employer in every establishment shall furnish
such information or return as may be prescribed in relation to vacancies appointed
for persons with disability that have occurred or are about to occur in that establishment
to such Special Employment Exchange as may be prescribed and the establishment
shall thereupon comply with such requisition.
b. The form in which and the intervals of time for which information or returns shall
be furnished and the particulars, they shall contain shall be such as may be prescribed.
4. Any person authorised by the Special Employment Exchange in writing, shall have access
to any relevant record or document in the possession of any establishment and may
enter at any reasonable time and premises where he believes such record or document
to be, and inspect or take copies of relevant records or documents or ask any question
necessary for obtaining any information.
5. Wherein any recruitment year any vacancy under Section 33, cannot be filled up due
to non-availability of a suitable person with disability or, for any other sufficient reason,
such vacancy shall be carried forward in the succeeding recruitment year and if in the
succeeding recruitment year also suitable person with disability is not available, it may
first be filled by interchange among the three categories and only when there is no person
with disability available for the post in that year, the employer shall fill up the vacancy
by appointment of a person, other than a person with disability:
Provided that if the nature of vacancies in an establishment is such that a given category
of person can not be employed, the vacancies may be interchanged among the three
categories with the prior approval of the appropriate Government.
152 Community Based Rehabilitation of Persons with Disabilities

6. a. Every employer shall maintain such record in relation to the person with disability
employed in his establishment in such form and in such manner as may be prescribed
by the appropriate Government.
b. The records maintained under sub-section (1) shall be open to inspection at all reasonable
hours by such persons as may be authorised in this behalf by general or special order
by the appropriate Government.
7. a. The appropriate Governments and local authorities shall by notification formulate
schemes for ensuring employment of persons with disabilities, and such schemes may
provide for—
• the training and welfare of persons with disabilities;
• the relaxation of upper age limit;
• regulating the employment;
• health and safety measures and creation of a non-handicapping environment in
places where persons with disabilities are employed;
• the manner in which and the persons by whom the cost of operating the schemes
is to be defrayed; and
• constituting the authority responsible for the administration of the scheme.
8. All Government educational institutions and other educational institutions receiving aid
from the Government, shall reserve not less than three percent seats for persons with
disabilities.
9. The appropriate Governments and local authorities shall reserve not less than three percent
in all poverty alleviation schemes for the benefit of persons with disabilities.
10. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide incentives to employers both in public and
private sectors to ensure that at least five percent of their workforce is composed of
persons with disabilities.
Annexures 153

AFFIRMATIVE ACTION

1. The appropriate Governments shall by notification make schemes to provide aids and
appliances to persons with disabilities.
2. The appropriate Governments and local authorities shall by notification frame schemes
in favour of persons with disabilities, for the preferential allotment of land at confessional
rates for—
a. House;
b. Setting up business;
c. Setting up of special recreation centres;
d. Establishment of special schools;
e. Establishment of research centres;
f. Establishment of factories by entrepreneurs with disabilities.
154 Community Based Rehabilitation of Persons with Disabilities

NON-DISCRIMINATION

1. Establishments in the transport sector shall, within the limits of their economic capacity
and development for the benefit of persons with disabilities, take special measures to—
a. adapt rail compartments, buses, vessels and aircrafts in such a way as to permit easy
access to such persons;
b. adapt toilets in rail compartments, vessels, aircrafts and waiting rooms in such a way
as to permit the wheel chair users to use them conveniently.
2. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide for—
a. installation of auditory signals at red lights in the public roads for the benefit of
persons with visually handicap;
b. causing curb cuts and slopes to be made in pavements for the easy access of wheel
chair users;
c. engraving on the surface of the zebra crossing for the blind or for persons with low
vision;
d. engraving on the edges of railway platform for the blind or for persons with low
vision;
e. devising appropriate symbols of disability;
f. warning signals at appropriate places.
3. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide for—
a. ramps in public buildings;
b. adaptation of toilets for wheel chair users;
c. braille symbols and auditory signals in elevators or lifts;
d. ramps in hospitals, primary health centres and other medical care and rehabilitation
institutions;
4. a. No establishment shall dispense with, or reduce in rank, an employee who acquires
a disability during his service.
Provided that if an employee, after acquiring disability is not suitable for the post
he was holding, could be shifted to some other post with the same pay scale and
service benefits.
Provided further that if it is not possible to adjust the employee against any post,
he may be kept on a supernumerary post until a suitable post is available or he attains
the age of superannuating, whichever is earlier.
b. No promotion shall be denied to a person merely on the ground of his disability.
Provided that the appropriate Government may, having regard to the type of
work carried on in any establishment, by notification and subject to such conditions,
if any, as may be specified in such notification, exempt any establishment from the
provisions of this section.
Annexures 155

RESEARCH AND MANPOWER DEVELOPMENT

1. The appropriate Governments and local authorities shall promote and sponsor research,
inter alia, in the following areas —
a. Prevention of disability;
b. Rehabilitation including community based rehabilitation;
c. Development of assistive devices including their psycho-social aspects;
d. Job identification;
e. On site modification in offices and factories;
2. The appropriate Governments shall provide financial assistance to universities, other
institutions of higher learning, professional bodies and non-governmental research-units
or institutions for undertaking research for special education, rehabilitation and manpower
development.
156 Community Based Rehabilitation of Persons with Disabilities

RECOGNITION OF INSTITUTIONS FOR


PERSONS WITH DISABILITIES

1. The State Government shall appoint any authority as it deems fit to be a competent
authority for the purposes of this Act.
2. Save as otherwise provided under this Act, no person shall establish or maintain any
institution for persons with disabilities except under and in accordance with a certificate
of registration issued in this behalf by the competent authority:
Provided that a person maintaining an institution for persons with disabilities
immediately before the commencement of this Act may continue to maintain such institution
for a period of six months from such commencement and if he has made an application
for such certificate under this section within the said period of six months, till the disposal
of such application.
3. a. Every application for a certificate of registration shall be made to the competent
authority in such form and in such manner as may be prescribed by the State
Government.
b. On receipt of an application under sub-section (7), the competent authority shall make
such enquiries as it may deem fit and where it is satisfied that the applicant has complied
with the requirements of this Act and the rules made thereunder it shall grant a
certificate of registration to the applicant and where it is not so satisfied the competent
authority shall, by order, refuse to grant the certificate applied for:
Provided that before making any order refusing to grant a certificate the competent
authority shall give to the applicant a reasonable opportunity of being heard and
every order of refusal to grant a certificate shall be communicated to the applicant
in such manner as may be prescribed by the State Government.
c. No certificate of registration shall be granted under sub-section (2) unless the institution
with respect to which an application has been made is in a position to provide such
facilities and maintain such standards as may be prescribed by the State Government.
d. A certificate of registration granted under this section,—
i. shall, unless revoked under section 53, remain in force for such period as may
be prescribed by the State Government.
ii. may be renewed from time to time for a like period; and
iii. shall be in such form and shall be subject to such conditions as may be prescribed
by the State Government.
iv. An application for renewal of a certificate of registration shall be made not less
than sixty days before the period of validity.
v. The certificate of registration shall be displayed by the institution in a conspicuous
place.
4. a. The competent authority may, if it has reasonable cause to believe that the holder
of the certificate of registration granted under sub-section (2) of section 52 has—
i. made a statement in relation to any application for the issue or renewal of the
certificate which is incorrect or false in material particulars; or
Annexures 157

ii. committed or has caused to be committed any breach of rules or any conditions
subject to which the certificate was granted, it may, after making such inquiry,
as it deems fit, by order, revoke the certificate:
Provided that no such order shall be made until an opportunity is given to
the holder of the certificate to show cause as to why the certificate should not
be revoked.
b. Where a certificate in respect of an institution has been revoked under sub-section
(1), such institution shall cease to function from the date of such revocation:
Provided that where an appeal lies under section 54 against the order of revocation,
such institution shall cease to function—
i. where no appeal has been preferred immediately on the expiry of the period
prescribed for the filing of such appeal, or
ii. where such appeal has been preferred, but the order of revocation has been upheld,
from the date of the order of appeal.
c. On the revocation of a certificate in respect of an institution, the competent authority
may direct that any person with disability who is an inmate of such institution on
the date of such revocation, shall be—
i. restored to the custody of her or his parent, spouse or lawful guardian, as the
case may be, or
ii. transferred to any other institution specified by the competent authority.
d. Every institution which holds a certificate of registration which is revoked under
this section shall, immediately after such revocation, surrender such certificate to the
competent authority.
5. a. Any person aggrieved by the order of the competent authority refusing to grant a
certificate or revoking a certificate may, within such period as may be prescribed
by the State Government, prefer an appeal to that Government against such refusal
or revocation.
b. The order of the State Government on such appeal shall be final.
6. Nothing contained in this Chapter shall apply to an institution for persons with disabilities
established or maintained by the Central Government or a State Government.
158 Community Based Rehabilitation of Persons with Disabilities

INSTITUTION FOR PERSONS WITH SEVERE DISABILITIES

1. The appropriate Government may establish and maintain institutions for persons with
severe disabilities at such places as it thinks fit.
a. Where, the appropriate Government is of opinion that any institution other than an
institution, established under sub-section (1), is fit for the rehabilitation of the persons
with severe disabilities, the Government may recognise such institution as an institution
for persons with severe disabilities for the purposes of this Act:
Provided that no institution shall be recognised under this section unless such
institution has complied with the requirements of this Act and the rules made
thereunder.
b. Every institution established under sub-section (1) shall be maintained in such manner
and satisfy such conditions as may be prescribed by the appropriate Government.
c. For the purposes of this section “person with severe disability” means a person with
eighty percent or more of one or more disabilities.
Annexures 159

THE CHIEF COMMISSIONER AND COMMISSIONERS


FOR PERSONS WITH DISABILITIES

1. a. The Central Government may by notification, appoint a Chief Commissioner for persons
with disabilities for the purposes of this Act.
b. A person shall not be qualified for appointment as the Chief Commissioner unless
he has special knowledge or practical experience in respect of matters relating to
rehabilitation.
c. The salary and allowances payable to and other terms and conditions of service
(including pension, gratuity and other retirement benefits) of the Chief Commissioner
shall be such as may be prescribed by the Central Government.
d. The Central Government shall determine the nature and categories of officers and
other employees required to assist the Chief Commissioner in the discharge of his
functions and provide the Chief Commissioner with such officers and other employees
as it thinks fit.
e. The officers and employees provided to the Chief Commissioner shall discharge their
functions under the general superintendence of the Chief Commissioner.
f. The salaries and allowances and other conditions of service of officers and employees
provided to the Chief Commissioner shall be such as may be prescribed by the Central
Government.
2. The Chief Commissioner shall—
a. coordinate the work of the Commissioners;
b. monitor the utilisation of funds disbursed by the Central Government;
c. take steps to safeguard the rights and facilities made available to persons with
disabilities;
d. submit reports to the Central Government on the implementation of the Act at such
intervals as that Government may prescribe.
3. Without prejudice to the provisions of section 58 the Chief Commissioner may on his
own motion or on the application of any aggrieved person or otherwise look into complaints
with respect to matters relating to—
a. deprivation of rights of persons with disabilities;
c. non-implementation of laws, rules, bye-laws, regulations, executive orders, guidelines
or instructions made or issued by the appropriate Governments and the local authorities
for the welfare and protection of rights or persons with disabilities, and take up the
matter with the appropriate authorities.
4. a. Every State Government may, by notification appoint a Commissioner for persons
with disabilities for the purpose of this Act.
b. A person shall not be qualified for appointment as a Commissioner unless he has
special knowledge or practical experience in respect of matters relating to rehabilitation.
c. The salary and allowances payable to and other terms and conditions of service
(including pension, gratuity and other retirement benefits) of the Commissioner shall
be such as may be prescribed by the State Government.
160 Community Based Rehabilitation of Persons with Disabilities

d. The State Government shall determine the nature and categories of officers and other
employees required to assist the Commissioner in the discharge of his functions and
provide the Commissioner with such officers and other employees as it thinks fit.
e. The officers and employees provided to the Commissioner shall discharge their
functions under the general superintendence of the Commissioner.
f. The salaries and allowances and other conditions of service of officers and employees
provided to the Commissioner shall be such as may be prescribed by the State
Government.
5. The Commissioner within the State shall—
a. coordinate with the departments of the State Government for the programmes and
schemes for the benefit of persons with disabilities;
b. monitor the utilisation of funds disbursed by the State Government;
c. take steps to safeguard the rights and facilities made available to persons with
disabilities;
d. submit reports to the State Government on the implementation of the Act at such
intervals as that Government may prescribe and forward a copy thereof to the Chief
Commissioner.
6. Without prejudice to the provisions of section 61 the Commissioner may on his own
motion or on the application of any aggrieved person or otherwise look into complaints
with respect to matters relating to—
a. deprivation of rights of persons with disabilities;
b. non-implementation of laws, rules, bye-laws, regulations, executive orders, guidelines
or instructions made or issued by the appropriate Governments and the local authorities
for the welfare and protection of rights of persons with disabilities, and take up the
matter with the appropriate authorities.
7. a. The Chief Commissioner and the Commissioners shall, for the purpose of discharging
their functions under this Act, have the same powers as are vested in a court under
the Code of Civil Procedure, 1908 while trying a suit, in respect of the following
matters, namely:—
i. summoning and enforcing the attendance of witnesses;
ii. requiring the discovery and production of any document;
iii. requisitioning any public record or copy thereof from any court or office;
iv. receiving evidence on affidavits; and
v. issuing commissions for the examination of witnesses or documents.
b. Every proceeding before the Chief Commissioner and Commissioners shall be a judicial
proceeding within the meaning of sections 193 and 228 of the Indian Penal Code and
the Chief Commissioner, the Commissioner, the competent authority, shall be deemed
to be a civil court for the purposes of section 195 and Chapter XXVI of the Code
of Criminal Procedure, 1973.
8. a. The Chief Commissioner shall prepare in such form and at such time for each financial
year as may be prescribed by the Central Government an annual report giving a full
account of his activities during the previous financial year and forward a copy thereof
to the Central Government.
Annexures 161

b. The Central Government shall cause the annual report to be laid before each House
of Parliament along with the recommendations explaining the action taken or proposed
to be taken on the recommendation made therein so far as they relate to the Central
Government and the reasons for non-acceptance, if any, of any such recommendation
or part.
9. a. The Commissioner shall prepare in such form and at such time for each financial year
as may be prescribed by the State Government an annual report giving a full account
of his activities during the previous financial year and forward a copy thereof to
the State Government.
b. The State Government shall cause the annual report to be laid before each State
Legislature along with the recommendations explaining the action taken or proposed
to be taken on the recommendation made therein in so far as they relate to the State
Government and the reasons for non-acceptance, if any, of any such recommendation
or part.
162 Community Based Rehabilitation of Persons with Disabilities

SOCIAL SECURITY

1. a. The appropriate Governments and the local authorities shall within the limits of their
economic capacity and development undertake or cause to be undertaken rehabilitation
of all persons with disabilities.
b. For purpose of sub-section (1), the appropriate Governments and local authorities
shall grant financial assistance to non-governmental organisations.
c. The appropriate Governments and local authorities while formulating rehabilitation
policies shall consult the non-governmental organisations working for the cause of
persons with disabilities.
2. a. The appropriate Government shall by notification frame an insurance scheme for the
benefit of its employees with disabilities.
b. Notwithstanding anything contained in this section, the appropriate Government may
instead of framing an insurance scheme frame an alternative security scheme for its
employees with disabilities.
3. The appropriate Governments shall within the limits of their economic capacity and
development shall by notification frame a scheme for payment of an unemployment
allowance to person with disabilities registered with the Special Employment Exchange
for more than two years and who could not be placed in any gainful occupation.
Annexures 163

MISCELLANEOUS

1. Whoever, fraudulently avails or attempts to avail, any benefit meant for persons with
disabilities, shall be punishable with imprisonment for a term which may extend to two
years or with fine which may extend to twenty thousand rupees or with both.
2. The Chief Commissioner, the Commissioners and other officers and staff provided to
them shall be deemed to be public servants within the meaning of section 21 of the Indian
Penal Code.
3. No suit, prosecution or other legal proceeding shall lie against the Central Government,
the State Governments or the local authority or any officer of the Government in respect
of anything which is done in good faith or intended to be done in pursuance of this
Act and any rules or orders made thereunder.
4. The provisions of this Act, or the rules made thereunder shall be in addition to, and
not in derogation of any other law for the time being in force or any rules, order or
any instructions issued thereunder, enacted or issued for the benefit of persons with
disabilities.
5. a. The appropriate Government may, by notification, make rules for carrying out the
provisions of this Act.
b. In particular, and without prejudice to the generality of the foregoing powers, such
rules may provide for all or any of the following matters, namely:—
i. the manner in which a State Government or a Union territory shall be chosen
under clause (k) of sub-section (2) of section 3;
ii. allowances which members shall receive under sub-section (7) of section 4;
iii. rules of procedure which the Central Coordination Committee shall observe in
regard to the transaction of business in its meetings under section 7.
iv. such other functions which the Central Coordination Committee may perform
under clause (h) of sub-section (2) of section 8;
v. the manner in which a State Government or a Union territory shall be chosen
under clause (h) or sub-section (2) of section 9;
vi. the allowances which the Members shall receive under sub-section (3) of section
9.
vii. rules of procedure which the Central Executive Committee shall observe in regard
to transaction of business at its meetings under section II;
viii. the manner and purposes for which a person may be associated under sub-section
(1) of section 12;
ix. fee and allowances which a person associated with the Central Executive Committee
shall receive under sub-section (3) of section 12;
x. allowances which members shall receive under sub-section (7) of section 14;
xi. rules of procedure which a State Coordination Committee shall observe in regard
to transaction of business in its meetings under section 17;
xii. such other functions which a State Coordination Committee may perform under
clause
164 Community Based Rehabilitation of Persons with Disabilities

xiii. of sub-section (2) of section 18;


xiv. the allowances which Members shall receive under sub-section (3) of section 19;
xv. rules of procedure which a State Executive Committee shall observe in regard
to transaction of business at its meetings under section 21;
xvi. the manner and purposes for which a person may be associated under sub-section
(1) of section 22;
xvii. fees and allowances which a person associated with the State Executive Committee
may receive under sub-section (3) of section 22;
xviii. information or return which the employer in every establishment should furnish
and the Special Employment Exchange to which such information or return shall
be furnished under sub-section (1) of section 34;
xix. the form and the manner in which record shall be maintained by an employer
under sub-section (1) of section 37;
xx. the form and manner in which an application shall be made under sub-section
(1) of section 52;
xxi. the manner in which an order of refusal shall be communicated under sub-section
(2) of section 52;
xxii. facilities or standards required to be provided or maintained under sub-section
(3) of section 52;
xxiii. the period for which a certificate of registration shall be valid under clause (a)
of sub-section (4) of section 52;
xxiv. the form in which and conditions subject to which a certificate of registration
shall be granted under clause (c) or sub-section (4) of section 52;
xxv. period within which an appeal shall lie under sub-section (1) of section 54;
xxvi. the manner in which an institution for persons with severe disabilities shall be
maintained and conditions which have to be satisfied under sub-section (3) of
section 56;
xxvii. the salary, allowances and other terms and conditions of service of the Chief
Commissioner under sub-section (3) of section 57;
• the salary, allowances and other conditions of service of officers and employees
under sub-section (6) of section 57;
• intervals at which the Chief Commissioner shall report to the Central
Government under clause (d) of section 58;
• the salary, allowances and other terms and conditions of service of the
Commissioner under sub-section (3) of section 60;
• the salary, allowances and other conditions of service of officers and employees
under sub-section (6) of section 60;
• intervals within which the Commissioner shall report to the State Government
under clause (d) of section 61;
• the form and time in which annual report shall be prepared under sub-section
(1) of section 64;
Annexures 165

• the form and time in which annual report shall be prepared under sub-section
(1) of section 65;
• any other matter which is required to be or may be prescribed.
3. Every notification made by the Central Government under the provision to section 33,
proviso to sub-section (2) of section 47, every scheme framed by it under section 27,
section 30, sub-section (1) of section 38, section 42, section 43, section 67, section 68 and
every rule made by it under sub-section (1), shall be laid, as soon as may be after it
is made, before each House of Parliament, while it is in session for a total period of
thirty days which may be comprised in one session or in two or more successive sessions,
and if, before the expiry of the session immediately following the session or the successive
sessions aforesaid, both Houses agree in making any modification in the rule, notification
or scheme, both houses agree that the rule, notification or scheme should not be made,
the rule, notification or scheme shall thereafter have effect only in such modified form
or be of no effect, as the case may be; so, however, that any such modification or annulment
shall be without prejudice to the validity of anything previously done under that rule,
notification or scheme, as the case may be.
4. Every notification made by the State Government under the provision to section 33,
proviso to sub-section (2) of section 47, every scheme made by it under section 27, section
30, sub-section (1) of section 38, section 42, section 43, section 67, section 68 and every
rule made by it under sub-section (1), shall be laid, as soon as may be after it is made,
before each House of State Legislature, where it consists of two Houses or where such
legislature consists of one House before that House.
Source: Government of India, Gazette Notification.
166 Community Based Rehabilitation of Persons with Disabilities

ANNEXURE II

IDENTIFICATION AND NEEDS ASSESSMENT OF BENEFICIARIES IN


COMMUNITY BASED REHABILITATION INITIATIVES
OPERATIONAL GUIDELINES

The formulation of an effective Community-based Rehabilitation (CBR) Programme begins


with defining the magnitude of the problem of disability in the community. Although costly
and time consuming, identification surveys are much cheaper than intervention itself. The
survey may suggest that the problem is far less than originally anticipated, and may also
suggest how rehabilitation activities (medical and surgical treatment, physiotherapy, speech
therapy, occupational therapy, vocational training, education, job placement, maintenance
allowance, other social security measures, recreation, leisure activities) can be planned.
Also, the survey may identify the types of disabilities and those peculiar to the geographical
setting (urban/rural/tribal etc).
A systematic and comprehensive preliminary investigation should preferably include the
following:
1. Awareness programmes in the community using locally familiar/popular media and audio-
visual presentations to create awareness among the people of the proposed interviews
and surveys. Various aspects of disability may be covered in these programmes using
hand bills, video films, esters etc. Local organisations such us schools, health centres
and so on should also be involved. It is important to assure local people that services
would be linked with the survey.
2. Collection of information from census reports (of the villages/slums/tribes). Contacting
officials of the departments of Economics and Statistics, Social Welfare, Development
and Fanchavathral, Disabled Welfare and oilier non-Governmental organisations (NGOs)
working in the area will be an additional help.
3. Interviews, following a structured questionnaire conducted with those individuals likely
to be aware of the problem, e.g. formal and informal leaders, local functionaries of
education, health, panchayat etc. traditional dais, elderly members of the community,
Anganawadi and Balawadi (pre-school) workers, members of the Mahila Mandals (women
groups) and youth organisations, rehabilitation centres and special schools (if any).
Identification (prevalence) surveys determine, the number of individuals in the sample
(or the whole population surveyed) with a particular impairment, disability or handicap
at that point of time. When this sample represents the population under consideration, the
prevalence rates within the sample represent those within the population as well.
Surveys involving assessment (at least preliminary assessment) components are the most
efficient and definitive (unbiased) means of:
1. Establishing the nature, magnitude and geographical distribution of different disabilities.
2. Determining whether it manifest itself as a significant public health problem.
3. Selecting suitable strategies for intervention.
Annexures 167

4. Providing a baseline for evaluating the effectiveness of future intervention programmes.


A survey of the entire population the chosen target area will give more accurate result.
Proforma 1 is to be used in the urban setting, while Proforma 2 is to be used in the
rural setting. Proforma 3 and its Annexures are for use in all setting.

PERSONNEL AND FIELD LEVEL ACTIVITIES


Keeping in mind the educational and experience profile of the community-based rehabilitation
worker, it is advisable to plan for gradation (severity of disability after detailed assessment
by resource personnal (doctor, physiotherapist, occupation therapist, special educator) of
completion of the survey.
The total population, covering both sexes and all age groups is to be included for the
survey.
Anganawadi workers, health workers, local youth and students voluted (and others)
may also be involved after being trained. It is essential for the personnel who do the
preliminary needs assessment (Appendix should deliver the services. With adequate training,
community-based rehabilitation personnel with high school/pre-university background
should be able to collect primary data.
The co-ordinator of the project and other supervisory staff who are trained in research/
survey methods (as per of their course in Master of Social work/Master of Sociology) are
to be involved in designing, supervising, analysing and preparation of the write up. Services
of a statistician available, may be utilised.
Training of survey personnel is of utmost importance. It is advisable to the personnel
involved in the survey undergo a fierce day orientation.
Day Time Content Method

1 9 am to a. What does impairment, disability and handicap mean? Lecture followed by


4 pm b. Causes and types of disabilities discussion
c. Possible interventions for different types of disabilities
d. Standard case definitions/case explanations
e. Proformae
2 9 am to Each community-based rehabilitation worker and co-ordinator Pilot survey in
4 pm visits at least one community and the project
area, completes proformae 1/2,
visits at least 50 households and
fills up proforma 3, completes needs
assessment of at least 10 disabled beneficiaries
3 9 am to Provide clarifications; prepare action Discussions
4 pm plan for the project area in consultation
with the enumerators and supervisors

It requires 2-3 hours to fill up performae 1 and 2 in each slum/village. Proforma 3 requires
8-10 minutes per household and appendix to 3 requires 30-40 minutes per disabled person.
Field activities need to be planned keeping in mind the following:
1. Number of slums/villages/tribal colonies in the project area with a breakdown of the
number of households in each of them.
168 Community Based Rehabilitation of Persons with Disabilities

2. Geographical terrain and distance between the villages/tribal colonies/slums, and the
project headquarters.
3. Transport facilities available.
4. Number of personnel available for conduct of the survey and their training.
Field practice can begin slowly, with one enumerator interviewing a family whilst the
other observes. This is one way of overcoming reticence and learning from one another’s
mistakes. As their confidence and skill levels increase, the staff can interview families on
their own, under supervision of the survey co-ordinator.
Enumerators need to visit each house in the cluster and keep a careful record of those
that are unoccupied, do not have disabled persons, or have disabled persons who are not
present at that time or where parents refuse to co-operate. Such data are important in
evaluating results for bias. If large numbers of families with disabled persons are away
in the fields or refuse to co-operate, it is reasonable to surmise that their characteristics
and risk of disability might be different from those of families that were interviewed.
If the houses are found locked, repeat visits should be made either early in the morning
or late in the evening (depending on the occupation of the local people). Information can
be collected from neighbours if repeat visits also fail.
After completing proforma 3 covering all house-holds, the numerator can later assemble
them at a central point.
Uniform case definitions are to be used by all the enumerators.
If cases of leprosy are identified, they should be referred to a nearby Government health
facility. Cured/arrested cases of leprosy with physical deformities may be referred for
rehabilitation on a case by case basis as the project deems fit.
If persons with epilepsy are identifieds they should be referred to a nearby Government
health facility for treatment. Disabilities that might have resulted from untreated epilepsy
may also be considered for rehabilitation.
The supervisors must check the accuracy of the enumerators be reinterviewing at least
10% of households, checking the need assessment of all disabled beneficial and participating
in the analysis of data. All forms should be reviewed at least twice for legibility, accuracy
and completion before entry into the computer (if available). Compute entry should be checked
by special edit programmes. Interview techniques should be standardized and poor quality
unenthusiastic workers must be replaced.
It is advisable to devote one day per week for data entry into master chart so that data
collection and compilation end almost simultaneously.

ANALYSIS OF DATA
Proforma 1 and 2
A summary report must be prepared for each slum/village and a consolidated report
compiled therefrom. The report should specifically touch upon:
1. Facilities of health, formal, informal and special education, vocational training, job
placement/self employment that are locally available.
Annexures 169

2. Other organisations (Government and NGO) working in the area with whom collaboration
is possible.
3. Leaders who could be involved to generate community involvement and participation
in community-based rehabilitation work.
4. Approximate number of disabled beneficiaries.

Proforma 3
Information collected in Proforma 3 (and its appendix) is to be analysed using the following
output tables:
1. Age and sex distribution of the whole population and disabled beneficiaries (disability
wise) for the unit population (village/slum/tribe) and for the whole project area.
2. Religion distribution for the unit population and total population.
3. Caste/ethnic group distribution of the unit population and total population.
4. Nature of occupation for the unit population and total population.
5. Distribution of population according to certain material assets.
6. Consolidated list of beneficiaries according to disability, for the unit population and for
the whole project area.
7. Results of preliminary needs assessment according to disability, for the unit population
and the whole project area.
The primary aim of using Proforma 3 is to identify disabled beneficiaries and to make
a preliminary needs assessment. It is then intended to make correlations with other
information collected. The output tables referred to help in analysis. These are the minimal
output tables from each project and depending on availability of local resources, manpower
and computers, other information collected in the Appendix to proforma 3 can also be analysed
and presented as part of the report. Some of the information collected in the proformae
may not be relevant for immediate use, but might be required at a later date.

INTERVENTIONS
Undertaking identification and preliminary needs assessment survey ultimately helps project
partners in making a Community Diagnosis the problem of disability. Once this is complete,
intervention needs to be planned in consultation with the project co-ordinator and experts
for each disabled person identified. A Community Diagnosis helps in proper budgetary
expenditure and makes the best use of available resources. The first step towards intervention
will be the detailed assessment of individual beneficiaries.
During the identification survey one might identify cases of epilepsy and perhaps also
witness an attack. In such an event, the following tips will be helpful:
• If the person falls down, let the fit run its course.
• Be calm and advise the others nearby not to be frightened.
• It is not necessary to move the person unless he is in the way of traffic or close to fire
or water.
• Fold a cloth and put it under the person’s head.
• Loosen any tight clothing.
170 Community Based Rehabilitation of Persons with Disabilities

When the unusual movements have stopped, turn the person on to his side so that the
tongue falls forward. Any saliva that is collected will flow out of his mouth, making it
easier the person to breathe.
Stay with the person for sometime after the fit is over and comfort him. You may have
to explain to him what has happened since at times he may not be aware that he has had
a fit. He will be tired and may sleep for sometime.
The person should then be referred to a Government facility for initiating treatment.

GUIDELINES FOR TRANSLATION OF PROFORMAE


All questions should be phrased in the basic working language of the field team, as well
as any local languages or dialects likely to be encountered.
Translated Proformae are to be pretested on a small sample of households and then
finalised. Ambiguous questions can then be changed.
The following points are to be kept in mind while briefing the survey personnel and
translating the proformae.
PROFORMA 1 One proforma for each of the urban slums
PROFORMA 2 One proforma for each of the villages/tribal colonies
Q. No. 5(1 & 2) People interviewed can be 4 to 8 members and it is preferable to include
one or two women.
Q. No. 7(1) Refers to the extension in which the slum is situated.
Q. Nos. 12(1); 13(2) Population details collected may be approximate ones.
Q. Nos. 17(1); 18(2) (a) To explore possibilities of referral support for medical/surgical
rehabilitation.
(b) To understand local practices and help referral of disabled person
during illness.
Q. Nos. 18(1) To develop liaison will referral centres for future collaboration in disability
19(2) prevention and rehabilitation programmes.
Q. Nos. 19 to 29(1) To make an assessment of the standard of living in the slum/village and
20 to 34 (2) available modes of transport.
Q. Nos. 34, 35(1) To explore possibilities for vocational training.
39, 40 (2)
Q. Nos. 36(1) To understand the pressing need of the community and to plan in making
41(2) welfare of disabled persons a felt need.
Q. Nos. 37(1) To involve the community in different facets of community-based
42(2) rehabilitation interventions.
Q. Nos. 38(1) To understand and avoid duplication of efforts, to facilitate collaboration
43(2) in various facets of disability related activities.
Q. Nos. 39(1) To understand and facilitate identification of community resources
44(2) available for vocational training/job placement and self employment.
Q. Nos. 40(1) To get an idea of the magnitude of disability in the slum/village.
45(2)
Annexures 171

Q. Nos. 41(1) To understand the current status of intervention for disability in the
46(2) community.
Q. Nos. 42(1) To determine the expectations of the community, to make the community
47(2) understand the limitations of the organisation and to guide the community.
Q. Nos. 43(1) To identify and explore community resources for community-based
49(2) rehabilitation activities.

A secondary school teacher conversant in the local language should be identified to review
translation work or to undertake translation work of the Proformae. It is important to ensure
“meaningful” translation rather than just transliteration.
Often, with the key informants, it may be possible to get an idea of the magnitude of
the problem before planning formal identification of beneficiaries. This also helps to involve
the community in the process. In some situations, key informant survey can be a substitute
for a door to door identification survey in rural settings.
PROFORMA - 3 One proforma for each household
Q. No. l7(V) To enquire whether persons with locomotor disability using wheelchairs
or aids and appliances can move freely in the home environment without
physical barriers.
Q. No. 18 Information collected will be approximate.
Q. No. 25 It will be difficult to record height (total length of the body) in the
case of severe locomotor disabilities. In such a situation, height may
be left unrecorded.
Q. No. 46 To understand hardship because of disability.
Q. No. 54 To comprehend social factors in the family having a bearing on
interventions for the disabled person. Inferences will have to be derived
later by indirect questions, observation and analysis.
Q. No. 56 To study aptitude for vocational training/job placement/self
employment for disabled persons.
Q. No. 57 To facilitate initial assessment and planning a time schedule of activities.

BIBLIOGRAPHY
1. Pruthvish S. and Thomas M. “Identification and Needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives” Actionaid Disability News. 1993;4:1.
2. Sommer A. “Field guide to the detection and control of xerophthalmia” WHO, Geneva, 1982.
172 Community Based Rehabilitation of Persons with Disabilities

PROFORMA 1

COMMUNITY PROFILE SURVEY

NAME OF THE PROJECT:


STATE:
One Proforma for each slum)

1. Date of Survey _____________ 2. Name of the interviewers ______


3. Interview started at _________ _______________________________
4. Interview concluded at _______ _______________________________
5. People interviewed:

Sl. No. Name Age Sex Educational Occupation Designation/Status/


Status Informality of
leadership
1.

2.
3.

4.
5.

6.
7.

8.
9.

6. Name of the slum ________ 7. Area in the City ________________________________


8. Name of the block ________ 9. Municipal Ward No. ____________________________
10. City ___________________
11. Distance of the slum from the project post _________________________________________
12. Total population: a. Males _____________________________________________________
b. Females ____________________________________________________
c. Total ______________________________________________________
13. Religionwise break-up of the population: (as percentage of total population)
a. Hindu ______________________
b. Muslim ____________________
c. Christian ____________________
Annexures 173

d. Sikh _____________
e. Others _____________
14. Most common cast/ethnic groups in the slum:
a. _____________
b. _____________
c. _____________
15. Availability of public or private transport from slum to the project post:

Mode of transport Availability Fare


Yes/No
(a) Bus
(b) Train
(c) Tempo
(d) Autorickshaw
(e) Others (Specify)

16. Details of educational facilities:

Name of educational Availability Distance Govt./ Available


facility Yes/No from Private mode of
the slum body transport

(a) Anganawadi
(b) Balawadi
(c) Adult education
centres
(d) Primary School
(e) Secondary School
(f) Junior College
(g) Degree College
(h) Technical Institutes
(i) Special Schools
(j) Others, (Specify)
174 Community Based Rehabilitation of Persons with Disabilities

17. Details of Health Facilities:

Details of health Availability Distance from Available mode


facilities Yes/No the slums of transport
(a) Services of health
worker from the
corporation
(b) Corporation
Dispensary
(c) Corporation
Maternity Home
(d) Private Hospital/
Nursing Home
(e) Civil Hospital/
Gen. Hospital
(f) Private Practitioners How many are Available mode Average cost
Available? of transport to per visit
reach them
(i) Modern Medicine
(ii) Ayurveda or Siddha
(iii) Homeopathy
(iv) Unani or Tibb
(v) Traditional Healer
(vi) Others (Specify)

18. Availability of services of the following functionaries:

Functionary Available Yes/No


(a) Health inspector of the Corporation

(b) Postman/Post Master


(c) Personnel from slum improvement
board
Annexures 175

19. Details of drinking water facilities:

Facility No. Available How many in use?

(a) Bore wells


(b) Dug wells

(c) Corporation public tap


(d) Water supply by lorries

20. Availability of street lights in the slum Yes/No


21. Availability of all weather roads Yes/No
22. Type of drainage facilities - Pucca drain Yes/No
- Open drain Yes/No
- Cesspool Yes/No
23. Availability of public lavatory Yes/No
24. No. of houses with TV sets/antenna: ________________________________
25. No. of houses with radio/tape recorder:________________________________
26. No. of houses with electricity: ________________________________
27. Main source of fuel used for cooking:
Percentage of
Homes with this
a. Gas connection __________________________________
b. Fire wood __________________________________
c. Kerosene __________________________________
d. Others __________________________________
28. No. of houses with cycles __________________________________
29. No. of houses with two wheelers __________________________________
30. No. of community halls __________________________________
31. No. of temples __________________________________
32. No. of churches __________________________________
33. No. of mosques __________________________________
34. Major occupation (s) of the people of the slum
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
35. Other occupations
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________
176 Community Based Rehabilitation of Persons with Disabilities

36. What is the most pressing need of the population in the slum?

37. List the names of the leaders/municipal council member/past council members, other
formal and informal leaders in the slums:

Name Designation

1.
2.

3.
4.

5.

38. List the names of the non-governmental organization/formal and non-formal groups
in the slum:

Sl. No. Name of the Nature of activity/ Contact person


organization activities
1.

2.
3.

4.
5.

6.

39. Tick the existing facilities in the slum (or nearby) which have potential for vocational
training:
a. Beedi rolling ( )
b. Agarbathi (incense stick) making ( )
c. Making baskets, mats ( )
d. Making papads/condiments ( )
e. Tailoring ( )
f. Construction work ( )
Annexures 177

g. Power looms ( )
h. Handlooms ( )
i. Printing ( )
j. Fruit vending/vegetable vending ( )
k. Dairy ( )
l. Poultry ( )
m. T.V. Repair/Radio Repair ( )
n. Others (Specify) ( )
40. If possible, please collect the following information:
a. Does anybody in your slum have difficulty
to see (visual impairment) Yes/No
to read (visual impairment) Yes/No
to hear (speech and hearing disabilities) Yes/No
to talk (speech and hearing disabilities) Yes/No
to stand (locomotor disabilities) Yes/No
to walk (locomotor disabilities) Yes/No
to kneel (locomotor disabilities) Yes/No
b. Does anybody in your slum have
history of fits (epilepsy) Yes/No
History of strange behaviour (mental illness) Yes/No
c. Does anybody in your slum have inability to understand what
they see/hear/touch/smell/taste (mental retardation) Yes/No
and/or
Responds slowly to what others say and to what
happens in their surroundings (mental retardation. Yes/No
d. Does anybody in you slum have Hansen’s disease (Leprosy) Yes/No
e. Any other persons with problems related to disability not
listed above Yes/No
41. If you know of persons with disability in the slum, tick the activities that have taken
place/are taking place for their welfare. (The interviewer should explain the following
items to the persons being interviewed in order to elicit the appropriate information.
1. Identification of disabled persons ( )
2. Assessment of disabled persons ( )
3. Medical/surgical treatment ( )
4. Physiotherapy ( )
5. Speech therapy ( )
6. Vocational training ( )
7. Job placement ( )
8. Admission to normal or special schools ( )
9. Use of aids and appliances ( )
10. Others (Specify) ( )
178 Community Based Rehabilitation of Persons with Disabilities

42. With respect of welfare of disabled persons, what does the community expect from the
organization?

43. What services can the community extend to support the organization in delivering
services?

44. Remarks of the interviewers:


This can include what the interviewer observed of the attitudes of persons being
interviewed)

_________________
_________________
Signature of Interviewers
Annexures 179

PROFORMA 2

COMMUNITY PROFILE SURVEY


NAME OF THE PROJECT:
STATE:
(One proforma for each village)

1. Date of Survey _____________ 2. Name of the interviewers _________


3. Interview started at _______________ _______________________________
4. Interview concluded at ____________ 5. Key informants interviewed:

Sl. No. Name Age Sex Educational Occupation Designation/Status/


Status Informality of
leadership
1.
2.

3.
4.

5.
6.

7.
8.

6. Name of the village ___________ 7. Hobli _______ 8. Ward _____


9. Name of the panchayat ______ 10. Taluk ______________________
11. District ____________________
12. Distance of the village from the project cost ___________________
13. Total population: a. Males _______________
b. Females _______________
c. Total _______________
14. Religionwise break-up of the population: (as percentage of total population)
a. Hindu ______________________
b. Muslim _____________________
c. Christian ____________________
d. Sikh _______________________
e. Others _____________________
180 Community Based Rehabilitation of Persons with Disabilities

15. Most common cast/ethnic groups in the village:


a. _____________
b. _____________
c. _____________

16. Availability of public or private transport from village to the project post:

Mode of transport Availability Fare


Yes/No

(a) Bus
(b) Train

(c) Tempo
(d) Autorickshaw

(e) Others (Specify)

17. Details of educational facilities:

Name of Availability Distance from Govt./Private Available


educational facility Yes/No the village body mode of
transport
(a) Anganawadi

(b) Balawadi
(c) Adult education
centres
(d) Primary School

(e) Secondary School


(f) Junior College

(g) Degree College


(h) Technical Institutes

(i) Special Schools


(j) Others (Specify)
Annexures 181

18. Details of Health Facilities:

Details of health Availability Distance from Available mode


facilities Yes/No the village of transport
(a) Sub-centre (with
services of health
worker)
(b) Primary health
centre
(c) Private Hospital/
Nursing Home
(d) District Hospital
(e) Private Practitioners How many are Available mode Average cost
Available? of transport to per visit
reach them
(i) Modern Medicine
(ii) Ayurveda or Siddha
(iii) Homeopathy
(iv) Unani or Tibb
(v) Traditional Healer
(vi) Others (Specify)

19. Availability of services of the following functionaries:


Functionary Available Yes/No
a. Traditional birth attendant
b. Village Health Worker
c. Postman/postmaster
d. Gramsevak
e. Agricultural Assistant
f. Sericultural Assistant
g. Panchayat Secretary
h. Others (Specify).
182 Community Based Rehabilitation of Persons with Disabilities

20. Details of drinking water facilities:

Facility No. Available How many in use?

(a) Bore wells


(b) Dug wells

(c) Pond/Tank
(d) River

(e) Water supply by lorries

21. Availability of street lights in the slum Yes/No


22. Availability of all weather roads Yes/No
23. Type of drainage facilities - Pucca drain Yes/No
- Open drain Yes/No
- Cesspool Yes/No
24. No. of cinema tents/theatres:
25. No. of houses with TV sets/antenna:
26. No. of houses with radios:
27. No. of electrified homes:
28. Main source of fuel used for cooking: Percentage of
Homes with this
a. Gas connection _________________________________________
b. Fire wood _________________________________________
c. Kerosene _________________________________________
d. Others (Specify) _________________________________________
29. No. of houses with cycles _________________________________________
30. No. of houses with bullock carts _________________________________________
31. No. of houses with two wheelers _________________________________________
32. No. of houses with tractors _________________________________________
33. No. of houses with four wheelers _________________________________________
34. No. of houses with tillers _________________________________________
35. No. of community halls _________________________________________
36. No. of temples _________________________________________
37. No. of churches _________________________________________
38. No. of mosques _________________________________________
39. Major occupation/s of the people of the village:
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
Annexures 183

40. Other occupations


1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________

41. What is the most pressing need of the population in the community?

42. List the names of the leaders/municipal council member/past council members, other
formal and informal leaders in the village:

Name Designation

1.
2.

3.
4.

5.
43. List the names of the non-governmental organization/formal and non-formal groups
in the village:

Sl. No. Name of the organization Nature of activity/activities Contact person

1.
2.

3.
4.

5.
6.

44. Tick the existing facilities in the village (or nearby) which have potential for vocational
training:
(a) Tailoring ( )
(b) Beedi rolling ( )
(c) Agarbathi (incense sticks) making ( )
(d)Making baskets/Mats ( )
184 Community Based Rehabilitation of Persons with Disabilities

(e) Sericulture ( )
(f) Dairy ( )
(g) Poultry ( )
(h) Fisheries ( )
(i) Pottery ( )
(j) Brick making ( )
(k) Making papads/condiments ( )
(l) Rope making ( )
(m)Construction work ( )
(n) Toy making ( )
(o) Handlooms ( )
(p) Power looms ( )
(q) Printing ( )
(r) Cow herding ( )
(s) Flower vending ( )
(t) Fruit vending/vegetable vending ( )
(u) Farming ( )
(v) Others (specify) ( )

45. (a) Does anybody in your village have difficulty:


To see (visual impairment) Yes/No
To read (visual impairment) Yes/No
To hear (speech and hearing disabilities) Yes/No
To talk (speech and hearing disabilities) Yes/No
To stand (locomotor disabilities) Yes/No
To walk (locomotor disabilities) Yes/No
To kneel (locomotor disabilities) Yes/No
(b) Does anybody in your village have
History of fits (epilepsy) Yes/No
History of strange behaviour (mental illness) Yes/No
(c) Does anybody in your village have inability to understand
what they see/hear/touch/smell/taste (mental retardation) Yes/No
and/or responds slowly to what others say and to what
happens in their surroundings (mental retardation) Yes/No
(d)Does anybody in you village have Hansen’s disease (Leprosy) Yes/No
(e) Any other persons with problems related to disability not
listed above Yes/No
Annexures 185

If yes to any of the previous questions, please enter details in the following table:

DETAILS OF DISABLED PERSONS

Sl. Name of the Type of Age Sex Marital Status Father Mother Occupation Income Educational
No. Disabled person disability (If adult) Name name Status

47. If you know of persons with disability in the village, tick the activities that have taken
place/are taking place for their welfare.
The interviewer should explain the following items to the key informants in order
to elicit the appropriate information).
1. Identification of disabled persons ( )
2. Assessment of disabled persons ( )
3. Medical/surgical treatment ( )
4. Physiotherapy ( )
5. Speech therapy ( )
6. Vocational training ( )
7. Job placement ( )
8. Admission to normal or special schools ( )
9. Use of aids and appliances ( )
10. Others (specify) ( )

48. With respect to welfare of disabled persons, what does the community expect from the
organization?
186 Community Based Rehabilitation of Persons with Disabilities

49. What services can the community extend to support the organization in delivering services?

50. Remarks of the interviewers:


(This can include what the interviewer observed of the attitudes of persons being
interviewed)
Annexures 187

PROFORMA 3

IDENTIFICATION AND NEEDS ASSESSMENT OF


DISABLED PERSONS
(One Proforma for each household)

Sl. No. of the Household


STATE:
1. Name of the Project: _________________________________________________________
2. Name of the Village/Slum: ___________________________________________________
3. Name of the Hobli/Municipal ward/Mandal/Panchayat: ________________________
4. Address/Landmark of the House: ____________________________________________
5. Name of the City/District: ___________________________________________________
6. Date of registration and initial assessment: ____________________________________
7. Name of the CBR worker: ___________________________________________________
8. Name of the Area Co-ordinator: ______________________________________________
9. Names of the Interviewers: ___________________________________________________
10. Name of the respondent: _____________________________________________________
Name of the disabled persons ____________ Age _______________ Sex ____________
11. Relationship of the respondent to the disabled person: _________________________
12. Family profile _______________________________________________________________

Sl. No. Names of the persons Age Sex Relationship to Educational Occupation Income per Marital Remarks
in the household the head of the status month status
family
188 Community Based Rehabilitation of Persons with Disabilities

13. Total family size:


a. Males:______________________________________________________________________
b. Females:____________________________________________________________________
c. Total No.: ___________________________________________________________________

14. Total income of the family per month Rs. ___________________________________________

15. Nature of family: Nuclear/Joint/Three Generation

16. Religion: Hindu/Muslim/Christian/Sikh/Others (Specify)_____________________________

17. Nature of the House in which the family lives:


i. In house Yes/No
ii. The bathroom Yes/No
iii. The Toilet Yes/No

18. Material assets:

Description Yes/No Quantum

(a) Dry land


(b) Wet lands
(c) Cattle
(d) Goat/Sheep
(e) Pigs
(f) Poultry
(g) Other farm animals,
(h) TV
(i) Radio
(j) Two wheeler
(k) Bullock cart
(l) Tractor/Tiller
(m) Four wheeler
(n) Sofa set
(o) Others (specify)

19.(a) Does anybody in your house have difficulty


to read (visual impairment) Yes/No
to hear (speech and hearing disabilities) Yes/No
to talk (speech and hearing disabilities) Yes/No
to stand (locomotor disabilities) Yes/No
to walk (locomotor disabilities) Yes/No
to kneel (locomotor disabilities) Yes/No
Annexures 189

b. Does anybody in your house have


History of fits (epilepsy) Yes/No
History of strange behaviour (mental illness) Yes/No
c. Does anybody in your house have inability to understand what
they see/hear/touch/smell/taste (mental retardation) Yes/No
and/or
responds slowly to what others say and to what happens in
their surroundings (mental retration) Yes/No
d. Does anybody in your, house have Hansen’s disease (Leprosy) Yes/No
e. Any other persons with problems related to disability not
listed above Yes/No
If yes, details ____________________________________
20. Do the disabled persons identified have more than one disability? Yes/No
If yes, details ____________________________________
21. If the family has children under 5 years, the interviewer should specifically ask each
mother the following ten questions:
1. Compares with other children, did the child have any serious delay in sitting, standing
or walking?
2. Does the child speak at all?
3. Can the child make himself understood in words: can he say recognizable words?
4. Does the child have difficulty in seeing?
5. Does the child have any difficulty in hearing?
6. When you ask the child to do something, does he seem to understand what you are saying?
7. Does the child have any weakness and/or stiffness in the limbs and/or difficulty in
walking or moving his arms?
8. Has the child often had fits, become rigid or lost consciousness in the last six months?
9. Has the child had any other serious accident or illness?
10. Compared with other children of his/her age, does the child appear in any way backward,
slow or dull?
Name of the child Age Sex If ‘Yes’ is the response to questions
1, 4, 5, 7 to 10, and ‘No’ to questions
2, 3 and 6 details of problems identified
1.

2.
3.
4.
190 Community Based Rehabilitation of Persons with Disabilities

If a disabled person is found in this house, please fill up Appendix to proforma 3. If there
are no disabled persons proceed to the next household.

One Appendix to proforma 3 is required for each disabled person. If more than one disable
person is found, use more Appendices to 3.
_______________________
_______________________
Signature of Interviewers
Source: Thomas Maya, Pruthvish S. “Identification and Needs Assessment of beneficiaries
in Community based rehabilitation initiatives” Monograph, ActionAid India, 1994.
Annexures 191

ANNEXURE TO PROFORMA 3

Name of the disabled person:


Age: Sex:
1. Who in the family is directly taking care of the disabled person?
2. Description of the disability in the disabled person:
(a) Type of disability or disabilities____________
(b) Age at onset ____________
(c) Duration of disability ____________
3. Height ________________________
4. Weight ________________________
5. Does the child or adult look malnourished? Yes/No
6. Immunization Status

Vaccine Received Not Received Do not Know

Bacille Calmette Guerin (BCG)

Diphtheria Pertussis Tetanus (DPT) 1st dose


2nd dose
3rd dose
Booster dose

Oral Polio Vaccine (OPV) 1st dose


2nd dose
3rd dose
Booster dose

Measles

Diphtheria and Tetanus Toxoids (DT)

8. Any history of consanguinity in the family? Yes/No


If yes, details
9. Any history of past illness?
(a) Measles ( ) (g) Poliomyelitis ( )
(b) Whooping cough ( ) (h) Injuries ( )
(c) Chicken pox ( ) (I) Brain fever ( )
(d)Hansen’s disease ( ) (j) Ear discharge ( )
(e) Tuberculosis ( ) (k) Night blindness ( )
(f) Convulsions ( )
if yes to any of the above, give details
192 Community Based Rehabilitation of Persons with Disabilities

10. History of major millestones of development (if a child) The interviewer should check
with the care giver about the development achieved by the child on each of the following
items and enter the same in the column below

SI. Child’s Progress Normal development Development achieved


No. (Age range) by the child

1. Responds to name/voice 1-3 months

2. Smiles at others 1-4 months

3. Holds head steady 2-6 months

4. Sits without support 5-10 months

5. Stands without support 9-14 months

6. Walks well 10-20 months

7. Talks in 2-3 word sentences 16-3 months

8. Eats/drinks independently 2-3 years

9. Tells name 2-3 years

10. Has toilet control 3-4 years

11. Avoids simple hazards 3-4 years

12. Fits/physical disability Yes/No

11. Place of delivery of the child


Home ( )
Hospital ( )
Other (specify) _________________

12. Personnel who conducted the delivery :


(a) Trained Dai ( )
(b) Untrained Dai ( )
(c) Family Member ( )
(d)Neighbour ( )
(e) Health worker ( )
(f) Doctor ( )

13. Was it a full term baby Yes/No


Premature baby Yes/No

14. Did the baby cry immediately after birth ? Yes/No

15. Was the baby blue at birth ? Yes/No


Annexures 193

16. Nature of intervention (if history is available) at the time of delivery


Normal delivery Yes/No
Forceps Yes/No
Cesarean section Yes/No
Oxytocin drip Yes/No
Others (specify) ______________________________
Birth weight of the baby ______________________________
(if available)

17. Describe in detail events immediately preceding the onset of disability

18. From the time that disability was identified, do you think it is increasing? Decreasing?
Remaining the same?

19. Does the disabled person have any other prolonged sickness? Yes/No
If yes, details __________________________

20. Does any other person in the family/relatives have similar or other
forms of disability Yes/No
If yes, give details __________________________

21. Probable causes of disability :

22. Has the person received any services/intervention for


disability ? Yes/No.

23. If yes, please give details as follows :


Sl. Nature of Interventions Place where Whether Govt/ Institution where Details of Cost
No. interventions voluntary agency interventions were interventions incurred
received

1. Assessment of disability
2. Medical/surgical treatment
3. Physiotherapy/speech therapy
4. Occupational therapy
5. Aids/appliances
6. Counseling
7. Normal school admission
8. Special school admission
9. Vocational training
10. Job placement/self employment
11. TRYSEM scheme
12. Physical handicap pension
13. Bus/train pass
14. Medical certificate
15. Scholarships
16. Others (specify)
194 Community Based Rehabilitation of Persons with Disabilities

24. Does the disabled person use aids/appliances? Yes/No


If yes, details_______________________________
25. Does the disabled person function only
(i) with aids and appliances Yes/No
if Yes, explain________________________
(ii) with manual help Yes/No
if Yes, explain________________________
26. (a) Has the disabled person used aids/appliances in the past? Yes/No
(b) If yes, specify
27. Why has he slopped using aids/appliances ________________________
(Aids and appliances specifically refer to callipers, crutches, artificial limbs, splints,
wheelchair, tricycle, walking stick, boots (surgical), slipper (surgical), hearing aid, white
cane, spectacles, Braille materials. teaching aids for MR children, others).
28. Educational and vocational training status of the disabled person (give details)
(a) Educational Status ________________________
(b) Vocational Training Status ________________________

[General details:
Illiterate, Primary School, High School, Diploma (specify). Degree (specify), Post-
Graduation (specify)
Technical details:
Certificate course. Diploma course, Degree course (specify)
Any trade, skill, craft Self-employment]
29. (a) Whether enrolled in regular educational institutions? Yes/No
(b) If no, explain why ________________________
(c) If yes, whether education is continuing to date? Yes/No
(d) If no, explain why________________________

30. (a) Whether he/she has ever enrolled in an institution for


disabled persons? Yes/No
(b) If yes, give details ________________________
31. (a) Does the disabled person earn any income? Yes/No
(b) If yes, give details ________________________
32. (a) Has the disability caused any change of job ? Yes/No
33. Is there any feature in the family (like alcoholism, broken home, psychiatric problems,
financial problems, etc.) which is likely to have or has a role in depriving the disabled
person from receiving training in activities of daily living skills (ADLS).
If yes, give details. ________________________
34. During the present visit and subsequent visits you will be making to this family, attitude
of family members, neighbours, etc, needs to be studied. It helps in planning
interventions for the disabled person. (Tick in the table below)
Annexures 195

Attitude of Positive Negative Indifferent

(a) Father
(b) Mother
(c) Wife
(d) Children
(e) Neighbours
(f) Peers
(g) Employer
(h) Colleagues at work
(i) Others (specify)

35. Aspirations of the disabled person.


If the disabled person is an adult or boy or girl aged above 10 years, he/she should
be questioned as to what aspirations he or she has with respect to education, vocational
training and job placement.

36. Having made an initial review of the disabled person, what interventions do you feel
are required and how will you plan the same:
SI. Interventions Required A How and when will you
No. Not Required B plan the same
Have to confirm C
(white the appropriate letter in
the column below)

1. Assessment
2. Activities of daily living skills (ADLS)
3. Medical/surgical treatment
4. Physiotherapy
5. Speech therapy
6. Occupational therapy
7. Aids/appliances
8. Counseling
9. Admission to normal school
10. Admission to special school
11. Vocational training
12. Job placement
13. TRYSEM scheme
14. Physical/handicap pension
15. Bus/train pass
16. Medical certificate
17. Scholarships
18. Others (specify)

37. Remarks of the interviewer :


(This can include what the interviewer observed of the attitudes of persons being
interviewed)
SCHEDULING ACTIVITIES FOR SURVEY

Identification and needs assessment of beneficiaries

1st month 2nd month 3rd month 4th month 5th month

Preparation of action plan

Translation of proformae

Printing/procurement of proformae

Identification of survey personnel

Identification of resource persons for


training

Training of survey personnel

Data collection and concurrent analysis

Consolidation of data

Report writing
196 Community Based Rehabilitation of Persons with Disabilities

Sharing of report with project staff

Sharing of report with others


BLANK FORMAT 1 FOR ANALYSIS OF SURVEY DATA

Prevalence Data

Name of the slum/village: No. of households visited :


Name of the CBR worker : No. of households locked:
Name of the area Co-ordinator : No. of households in which disabled persons were present, but were
not available at the time of survey:

POPULATION DATA DATA ON DISABLED PERSONS

Female Total Locomotor Communication Visual Mental Epilepsy Leprosy Mental Multiple Others Total
disabilities disabilities disabilities retardation illness disabilities

M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T
Annexures 197
BLANK FORMAT 2 FOR SURVEY DATA ANALYSIS
198

Material No of Families Percentage

No. of families with > 5 acres of dry land

• • • • > 1 acre of wet land

• • • • > 2 cows

• • • • > 6 goats/sheep

• • • • > 6 birds (poultry)

• • • • other farm animals (specify)

• • • • T.V. Sets

• • • • Radios

• • • • Two wheelers

• • • • Bullock Cart

• • • • Tractor
Community Based Rehabilitation of Persons with Disabilities

• • • • Car

• • • • Sofa set

• • • • other sets, specify

Distribution of population according to material assets


BLANK FORMAT 5 FOR SURVEY DATA ANALYSIS
List of Disabled Beneficiaries * BLANK FORMAT 3 FOR SURVEY
Name of the slum/village
DATA ANALYSIS
Religion No. of Families %
Mother’s/Guardian’s Age Sex Family income Occupation** Landmark of Type of
Name per month the house disability HINDU

MUSLIM

CHRISTIAN

SIKH

OTHERS

TOTAL

DISTRIBUTION OF FAMILIES ACCORDING


TO RELIGION

BLANK FORMAT 4 FOR SURVEY


DATA ANALYSIS

No. %
NATURE OF HOUSING

OWN HOUSE

RENTED HOUSE

TOTAL
* If is useful to compute this table disabilitywise for each vilage/slum and then a consolidated list
is to be prepared for the whole project area. DISTRIBUTION OF FAMILIES ACCORDING
** to be filled up (for adults only) if relevant TO HOUSING
Annexures
199
Contd...
BLANK FORMAT 6 FOR SURVEY
BLANK FORMAT 5 FOR SURVEY DATA ANALYSIS DATA ANALYSIS

NUMBER OF DISABLED BENEFICIARIES NEEDING SPECIFIC


SI. House Name of the Father’s
INTERVENTIONS IN THE SLUM/VILLAGE*
No. No. Disabled Person Name
Visual Mental Epilepsy Mental Leprosy Multiple Others Total Remarks
disabilities retardation Illness disabilities
200 Community Based Rehabilitation of Persons with Disabilities

PRELIMINARY NEEDS ASSESSMENT OF IDENTIFIED BENEFICIARIES


* It is useful to compute this table village/slumwise and then a consolidated table is to be
prepared for the whole project area.
Annexures 201

BLANK FORMAT 7 FOR SURVEY


DATA ANALYSIS

Sl. Nature of need Locomotor Communication


No. disabilities disabilities

1. Assessment

2. Activities of daily living skills

3. Medical/surgical treatment

4. Physiotherapy

5. Occupational therapy

6. Aids/apliances

7. Counselling

8. Admission to normal schools

9. Vocational training

10. Job placement

11. Trysem scheme

12. Physical handicap pension (maintenance allowance)

13. Bus/train pass

14. Medical certificate

15. Income certificate

16. Others, (specify)

17. Scholarship

18. Loan

19. Admision to special schools

20. 23 old age pension


202 Community Based Rehabilitation of Persons with Disabilities

HOW TO IDENTIFY HANSEN’S DISEASE (LEPROSY)

Leprosy in a majority of instances, can be identified only on the basis of a proper inspection.
a. A thorough inspection of the body surface (skin) to the extent permissible in good natural
light for the presence of tell tale evidence of leprosy.
b. Feeling the commonly involved peripheral nerve for the presence of thickening and/
or tenderness, e.g. inner part of elbow; behind the ear; outer part of the knee, outer
part of the ankle; etc.
c. Testing for loss of sensation of pain (using a skin needle) or light touch, (e.g. wisp of
cotton wool).
d. Deformities like paralysis of muscles of hand and feet; claw hand; loss of fingers or
toes; foot drop; claw toes and other deformities.
e. If there is a doubt in diagnosis, refer the person to the nearest health facility and follow-
up.

SOURCES
1. ICMR Centre for Advanced Research on Community Mental Health. “Features of Mental
Disorders’, Department of Psychiatry, National Institute of Mental Health and
Neurosciences (NIMHANS), Bangalore, India, 1988.
2. Larson H. (Ed). “Childhood Disability Information Kit”, UNICEF, Kathmandu, Nepal,
1983.
3. Minairc P. “The use of International Classification of Impairments, Disabilities and
Handicaps (ICIDH) in Rehabilitation”, Strasbourg, Council of Europe, Publications and
Documents Division, 1989.
4. Park J.E. and Park K. “Text Book of Preventive and Social Medicine”, Banarasidas Banot,
Calcutta, 1989.
5. Pruthvish S. and Thomas M. “Identification and Needs Assessment of Beneficiaries
in Community Based Rehabilitation Initiatives”, ActionAid Disability News, Vol 4. No.l,
1993.
6. National Institute for the Mentally Handicapped. “Mental Retardation - A Manual
for Village Rehabilitation Workers’, Secundrabad, India, 1988.
7. “Sarvekshna”, Journal of the National Sample Survey Organisation, Department of
Statistics, Ministry of Planning, New Delhi, Vol.VII, No. l-2, 1983.
8. Pahwa A. (Ed). Il Li dn on Community Based Rehabilitation”, District Rehabilitation
Centre Scheme, Ministry of Welfare, Govt. of India, New Delhi, 1990.
9. World Health Organisation. “Training in the Community for People with Disabilities”,
Geneva, 1989.
10. Dr. Maya Thomas and Dr. S. Pruthvish (1994) “Identification and Needs Assessment
of beneficiaries in Community-based rehabilitation initiatives” Monograph, ActionAid
India.
Annexures 203

ANNEXURE III

PER THOUSAND DISTRIBUTION OF PERSONS


WITH A PARTICULAR DISABILITY

Table AIII.1: Visual disability


Causes of disability Rural Urban

Sore eyes during first month of life 5 3


Sore eyes after the month 6 8
Severe diarrhoea before 6 years of age 11 13
Cataract 236 280
Glaucoma 34 42
Corneal opacity 13 16
Other eye diseases 130 107
Smallpox 29 35
Burns 2 5
Injuries other than burns 32 35
Medical/Surgical intervention 18 38
Old age 362 273
Other reasons 49 74
Not known 72 71
Total 999 1000
The overwhelming share of cataract, old age and injuries among causes of visual disability
is too obvious.
Table AIII.2: Hearing disability

Causes Rural Urban


German measles/rubella 9 14
Noise induced hearing loss 17 18
Ear discharge 175 143
Other illnesses 186 197
Burns 2 2
Injury other than burns 35 52
Medical/surgical intervention 10 21
Old age 310 316
Other reasons 77 88
Not known 179 149
Total 1000 1000
For about 31 percent, the cause is old age. For a large number, the reasons are not known.
Ear discharge, too, is an important reason for this disability.
204 Community Based Rehabilitation of Persons with Disabilities

Table AIII.3: Speech disability

Causes of disability Rural Urban


Hearing impairment 36 32
Voice disorder 90 63
Cleft palate 26 14
Paralysis 191 240
Mental illness/retardation 91 90
Other illness 221 207
Burns 4 6
Injury other than burns 32 47
Medical/surgical intervention 15 29
Old age 25 27
Other reasons 72 81
Not known 197 164
Total 1000 1000
It would be seen that unlike visual and hearing disabilities, old age is not a prominent
cause of this disabililty. About 9 percent acquired this disability due to mental illness/
retardation. Paralysis and other illnesses were the cause in about 40 percent of the cases.

Table AIII.4: Locomotor disability


Causes Rural Urban
Cerebral palsy 48 43
Polio 328 346
Leprosy 30 19
Stroke 29 41
Arthritis 20 19
Cardio-respiratory diseases 4 5
Other illnesses 112 115
Burns 22 15
Injury other than burns 211 225
Medical/Surgical intervention 22 34
Old age 62 49
Not known 60 44
Total 1002 999
It would be seen that polio is the cause of this disability in about one-third of cases.
Burns and injuries are the cause in nearly one-fourth of the cases. In about 2-3 percent cases,
the cause is leprosy.
Annexures 205

Table AIII.5: Estimated number (in 000) of disabled persons by


type of disability and sex (all-India)

Sl. Type of disability Rural Urban


No. Male Female Persons Male Female Persons
1. Physical disability* 7442 5210 12652 2078 1424 3502

2. Visual disability 1539 1796 3335 308 362 670


3. Hearing disability
(5 years and above) 1409 1164 2573 339 330 669

4. Speech disability
(5 years and above) 942 557 1499 298 169 467
5. Hearing and/or speech
disability (5 years and 2009 1490 3499 557 426 983
above)
6. Locomotor disability 4396 2411 6807 1370 762 2132

Estd. (000) total persons 326820 307537 634357 117121 104640 221761
based on 1991 Census
population

* At least one of (i) visual, (ii) hearing, (iii) speech and (iv) locomotor disability.
** The total estimated population is obtained by using 1991 census population projected
for 1st October, 1991.
206
Table AIII.6: Per 1000 distribution of households which reported at least one disabled person by number of
disabled persons in the household and average household size

State/U.T. Rural Urban


No. of disabled No. of disabled
size

size
person

person
persons persons
one disabled

P.C. of hrs
P.C. of hrs.

one disabled
Average hh.
which at least

Average hh.
1 2 3 or more 1 2 3 or more

. which atleast
Andhra Pradesh 914 81 5 4.9 9.98 922 69 8 5.3 7.67
Assam 951 47 2 5.6 5.61 972 25 3 6.0 4.86
Bihar 934 63 3 6.0 7.45 914 84 3 6.8 6.67
Gujarat 936 59 5 6.0 8.30 929 65 6 5.7 7.72
Haryana 900 97 4 6.7 9.73 925 71 4 5.5 5.78
Himachal Pradesh 892 105 3 6.3 13.62 917 79 4 4.8 3.98
Karnataka 923 70 7 6.1 10.06 929 67 4 6.1 6.38
Kerala 934 63 3 5.6 8.59 923 73 4 5.9 7.73
Madhya Pradesh 914 82 5 6.3 9.94 923 7 4 6.5 6.95
Maharashtra 901 95 4 5.6 9.64 919 75 6 5.4 6.81
Orissa 933 66 1 5.3 10.48 923 66 10 5.3 7.79
Punjab 882 113 4 6.3 13.95 913 82 5 5.6 7.63
Community Based Rehabilitation of Persons with Disabilities

Rajasthan 913 84 4 6.6 8.55 923 72 5 6.4 6.70


Tamil Nadu 913 83 5 4.5 9.09 926 70 4 5.0 7.19
Uttar Pradesh 925 72 3 6.3 9.25 923 72 5 6.5 7.21
West Bengal 934 60 6 6.0 8.13 945 54 1 5.6 5.77
All India 920 76 4 5.8 9.15 925 70 5 5.8 6.76
Table AIII.7: Per 1000 distribution of disabled persons by degree of
disability for each sex
. Rural Urban
Degree of disability Degree of disability
Cannot Can Can Total Estd. Cannot Can Can Total Estd.
State/U.T function function function (including (000) function function function (including (000)
even only without NR) No. of even only without NR) No. of
with with aid Disabled with with aid Disabled
aid aid aid aid

Andhra Pradesh 224 154 617 1000 654 206 143 648 1000 194
Assam 212 191 591 1000 149 191 341 465 1000 19
Bihar 257 157 570 1000 785 253 188 544 1000 109
Gujarat 190 170 625 1000 785 166 186 646 1000 130
Haryana 213 210 573 1000 250 216 243 540 1000 36
Himachal Pradesh 260 174 557 1000 84 305 163 464 1000 3
Karnataka 214 200 582 1000 374 160 178 654 1000 121
Kerala 242 193 555 1000 237 208 192 594 1000 76
Madhya Pradesh 266 175 552 1000 607 223 191 583 1000 149
Maharashtra 173 138 683 1000 853 152 186 655 1000 297
Orissa 206 132 659 1000 337 137 289 566 1000 46
Punjab 172 163 652 1000 260 172 152 667 1000 66
Rajasthan 258 189 547 1000 384 216 149 627 1000 60
Tamil Nadu 145 185 663 1000 473 117 173 699 1000 204
Uttar Pradesh 286 161 546 1000 1356 274 169 553 1000 272
West Bengal 195 123 674 1000 534 147 163 687 1000 173
All-India 229 164 599 1000 7442 188 180 625 1000 2078
Annexures
Estd. (000) No. of Disabled

207
208 Community Based Rehabilitation of Persons with Disabilities

Table AIII.8: Per 1000 distribution of persons with locomotor disability by


cause of disability

Injury other than burns


Cardio respiratory

Medical/surgical
Cerebral Palsy

Other reasons
Other illness

intervention

Not known
Arthritis

Old age
Leprosy

diseases
Stroke

Burns
Polio
State

Andhra Pradesh 24 425 23 86 9 2 66 11 195 21 56 47 35

Assam - 81 - 70 19 42 249 - 166 49 76 62 186

Bihar 48 432 8 37 29 10 84 11 163 13 9 59 96

Gujarat 53 233 2 14 19 7 199 8 215 92 56 40 57

Haryana 59 340 8 30 - - 137 23 256 30 12 36 71

Himachal Pradesh 14 31 - 128 - - 130 26 356 48 14 179 73

Karnataka 17 356 2 93 9 - 86 29 199 22 45 67 63

Kerala 35 308 14 54 21 - 100 15 201 39 62 78 72

Madhya Pradesh 86 366 4 3 13 7 94 22 207 46 31 51 70

Maharashtra 61 352 5 45 31 7 86 9 189 29 77 64 45

Orissa 25 178 177 28 66 4 105 16 194 13 33 64 95

Punjab 32 334 - 11 9 4 141 16 376 15 20 29 24

Rajasthan 34 430 3 7 9 11 160 6 198 49 14 36 42

Tamil Nadu 18 354 25 63 15 6 160 19 210 25 31 32 42

Uttar Pradesh 64 436 5 1 7 - 104 13 243 35 7 38 46

West Bengal 24 167 90 90 36 5 124 19 272 43 33 43 53

All-India 43 346 19 41 19 5 115 15 225 34 47 49 44

Source: Government of India, NSSO–1991


Pandey R.S. and Bhushan Punani “Perspectives in disability and rehabilitation” ActionAid India – 1993.
Annexures 209

ANNEXURE IV

Global Magnitude and Basic Facts Related to Childhood Disability


An estimated 120 to 150 million of the world’s 500 to 600 million disabled persons are
children. Almost 80 percent of disabled persons live in developing countries, mostly in
poor rural areas.
WHO estimates that only 5 percent of disabled children in developing countries have
access to rehabilitation of any kind.
According to UNESCO, less than 2 percent of disabled children attend schools.

Main Causes
One child in ten is born with or acquires a physical, mental, sensory, intellectual or
psychological disability due to preventable disease, congenital causes, malnutrition,
micronutrient deficiencies, accidents and injuries, armed conflict and landmines:
500,000 children lose some or part of their vision due to vitamin A deficiency. Iodine
deficiency disease (IDD) is a leading cause of mental retardation and physical disability.
An estimated 28 million babies are born each year at risk of mental impairment due
to insufficient iodine in their mothers’ diets. At least 140,000 children become disabled by
poliomyelitis (polio).
For every child killed by armed conflict, three are injured and permanently disabled.
More than 6 million children have become disabled in the past two decades and only 10
to 20 percent of those in need of prosthetics and other supports had access to them.
Fourty percent of the 26,000 persons killed and injured by landmines every year are
children. Over 10 million children are psychologically traumatized by armed
conflicts.

Suggested Policies and Programmes of UNICEF


To prevent disabilities from becoming handicaps and to advocate for effective therapy and
rehabilitation, early identification needs to be expanded and strengthened.
For normal growth and development of children who are already disabled, early and
continued therapeutic intervention, necessary assistive devices, prosthetics, education and
rehabilitation services are essential.
Collaboration with governments, UN agencies, NGOs and Civil Society, especially in
CBR, inclusive education, preparation for employment, sports and recreation for physical
development, need to be expanded.
Capacity building and resource mobilization: There is a great gap in the area of rehabilitation
and different forms of physical therapy, as well as a need for assistive devices, teaching
materials and training resources.
There is also great need for collaboration at the family and community level for better
use of resources.
210 Community Based Rehabilitation of Persons with Disabilities

Situation analysis and data collection: Accurate data on the magnitude, prevalence and types
of disabilities among children is essential for programme planning and implementation.
National census and surveys should include information on childhood disabilities.
Inclusive education and vocational training: Approximately 98 percent of children with disabilities
have no access to schools. Education, social integration and preparation for a productive
life of youth with disabilities need priority attention.
Public education and advocacy: Children and persons with disabilities are stigmatized and
negatively portrayed in many societies, even by the official media. Media campaigns should
emphasize the potential contribution of children with disabilities.
Legislation in conformity with the CRC: Some countries need assistance developing legislation
in conformity with the CRC and the UN standard rules on equalization of opportunities
for persons with disabilities.
Early intervention, including early detection and identification during the first four
years of life, is particularly critical for infants with disabilities and their families. Failure
to provide intervention and support to parents and caregivers, results in secondary disabling
conditions which further limit the child’s capacity to benefit from educational opportunities.
This is an area where multisectoral collaboration is essential, involving health, education,
social welfare and community development.

Source: www.unicef.org
Annexures 211

ANNEXURE V

A CALL FOR ACTION

Recognising the fact that the pace of implementation of “The Persons with Disabilities Act,
1995” has been dismally slow and keeping in mind the urgent need to fulfil the promises
made under the Act, we, the representatives of the civil society met in New Delhi on 5
and 6 October 1998, and having conducted a detailed review of the progress in the
implementation of the Act, do hereby call on the following to immediately undertake the
steps outlined hereunder to secure the welfare, empowerment and rights of the disabled
persons.

Central and State Governments


• The chief commissioner and commissioners in the state should be made full-time
functionaries with independent charge by June 1999 ensuring as far as practicable that
persons with disability possessing the required qualification and experience should be
appointed as chief commissioner and commissioners on the lines of the women’s
commission, commission for SC and ST and minorities commission.
• The central and state co-ordination and executive committees must meet as specified
in the Act, and minutes of the same must be widely publicised henceforth.
• Co-ordination and executive committees at the central and state levels must have a greater
representation of people with disabilities (PWDs) and NGOs working with PWDs in
order to have a balanced representation.
• The central and state co-ordination committees should evolve appropriate policies, detailed
rules and targets in a period of six months within the framework of the decade targets
of UN ESCAP for which India is a signatory.
• The banking and financial institutions must be coopted to the executive committee at
the central and state levels to facilitate self-employment and income generation
programmes.
• The chief commissioner and commissioners must meet PWDs and organisations of PWDs
on an intensive basis at least twice a month and reflect their concerns and suggestions
in the official process.
• The government should immediately promote translation of the Disability Act into all
regional languages and disseminate it widely within the Government, industry, NGOs
and the public at large.
• While implementing the Act, special emphasis needs to be placed on women and girls
with disability, the severely disabled and PWDs in rural areas.
• While designing programmes for implementation of the Act, the needs of people with
all disabilities should be given adequate attention.
• The existing mechanism for inter-departmental coordination at the central, state and
district levels should be strengthened for prevention, early identification and early
intervention for disabilities.
212 Community Based Rehabilitation of Persons with Disabilities

• Governments should widely consult organisations of PWDs and hold public hearings
while preparing amendments to the existing Act and in formulating policies for the
disabled.
• Governments should not misinterpret the clauses and deny opportunities to students
learning what they want. In fact, disabled students should be given opportunities to
participate in all regular and co-curricular activities like their non-disabled counterparts.
• Governments should encourage and promote quality needs-based research in the areas
of human power development, delineating prevalence and incidence of disabilities,
appropriate technology, material development linking universities and NGOs.
• The concerned authorities must promote a non-handicapping environment by providing
guidelines on barrier-free buildings, signage, modification to public transport, designated
parking spaces in all public places, etc.

NGOs
• Closely watch, monitor and influence the governments to implement the Act and achieve
set targets.
• Support the governments to undertake orientation programmes for government personnel,
employers, the general public, etc.
• Motivate, educate and sensitise the Government, panchayat members, the general public
and employers to take a proactive role towards all areas of welfare, empowerment and
rights of disabled people.
• Provide resource base and support to Governments for implementing the Act.
• Prepare a training package converting the Act into awareness-raising material and train
parents of the disabled and PWDs through training programmes.
• Design, develop and conduct leadership training programmes for persons with disability,
parents and NGO members, especially groups of disabled persons, to take up professional
advocacy work in respect of the Act.

International Agencies
• Support NGOs, government and disabled persons’ organisations in the implementation
of the Act.
• Support policy development, information exchange, material development, training and
networking among NGOs, Disabled Persons’ Organisations, academic and research
institutions, Government, etc.

Corporate Sector
• Ensure a barrier-free environment in places of work. Also ensure safety and equal
opportunities to PWDs.
• Employ at least 5 percent of the work force at all levels from among persons with disability.
• Support the Government to establish and maintain support systems for the care of the
severely disabled, one in each district.
• Apex bodies like CII, ASSOCHAM, FICCI should educate and motivate employers
regarding the provisions of the Act to secure effective implementation.
Annexures 213

Support Institutions
(Research Institutes, Academic Institutions, Universities, Specialist Hospitals, National
Institutes, Rehabilitation Institutions run by NGOs and Governments)
• Undertake research into needed curricular changes, appropriate technology for service
delivery and aids and appliances towards implementation of the Act.
• Undertake research into various facets of Community-Based Rehabilitation (CBR).

Media
• To regularly inform the public of news and activities pertinent to people with disabilities
as well as publicise issue-based stories.
• To act as a watchdog and ensure that the disabilities Act is implemented in letter and
spirit.

Public
• Support and encourage families with PWDs, particularly those based in rural areas, to
ensure education, skill training, social integration and employment of persons with
disability.
• Ensure that roads, buildings, religious places, shops, schools, marriage halls, etc. are
accessible to PWDs.
• Co-operate with the Government, NGOs and disabled persons’ organisations to develop
Community-Based Rehabilitation programmes and a barrier free environment for persons
with disability.
• Perform local fund-raising, and join hands with the government and NGOs to take
responsibility for disability programmes.
‘A Call for Action’ was arrived at during the National Advocacy Workshop held at United
Services institution at New Delhi (5 and 6 October 1998). The endeavour was organised
by National Centre for the Promotion of Employment for Disabled People (NCPEDP), New
Delhi, Concerned Action Now (CAN), Council for Advancement of People’s Action and
Rural Technology (CAPART) and ActionAid India.

Source: ActionAid Disability News, 1998.


ANNEXURE VI
Table AVI.1: Number of children with delay in attaining specified developmental
milestones per 1000 children for each state/U.T.

. Type of Developmental milestones for Children of Age

1-14 Years 2-14 years 3-14 years 1-14 years 10-14 years
State / U.T
Head Rolling Sitting Walking Talking Slow/lagging Performing Comprehending Development of Money
control behind in daily instructions speech and handling
development routine language

Andhra Pradesh 14 24 17 43 44 25 53 48 36 47
Arunachal Pradesh 412 378 413 435 406 54 195 226 118 82
Assam 171 161 129 146 153 71 163 216 125 131
Bihar 155 187 100 111 94 36 63 96 101 126
Goa 128 270 90 5 - 5 23 90 63 5
Gujarat 116 141 45 62 87 15 23 26 84 45
Haryana 33 122 9 16 6 31 45 40 75 44
Himachal Pradesh 139 116 34 30 18 22 42 103 109 100
Jammu & Kashmir 45 121 19 33 13 40 46 60 95 120
Karnataka 24 40 25 40 23 14 10 20 54 57
Kerala 21 22 11 10 9 15 21 11 38 56
Madhya Pradesh 154 175 101 92 70 36 76 81 97 107
Maharashtra 48 61 33 34 26 31 25 24 48 50
Manipur 24 146 24 22 59 16 18 32 44 68
Meghalaya 45 113 106 28 20 19 36 52 47 45
Mizoram 155 22 0 7 4 9 60 63 18 15
Nagaland 648 677 536 634 186 92 166 166 209 107
Orissa 28 47 33 32 29 47 60 65 53 118
Punjab 13 68 28 45 37 49 51 51 61 87
214 Community Based Rehabilitation of Persons with Disabilities

Rajasthan 63 97 35 61 29 32 77 90 81 124
Sikkim 71 84 81 105 31 55 97 145 61 14
Tamil Nadu 57 52 39 49 43 38 30 38 34 41
Tripura 251 275 199 218 158 64 50 122 68 151
Uttar Pradesh 156 169 93 90 62 22 50 52 77 140
West Bengal 78 102 60 49 34 44 78 106 78 102
A & N Island 38 21 25 14 10 13 5 17 12 49
Chandigarh 0 2 1 15 4 1 4 3 25 6
Dadra & Nagar Haveli 26 17 1 11 9 4 2 1 5 237
Daman & Diu - 2 - 3 2 2 5 4 52 2
Delhi - - - 1 1 2 - - 21 71
Lakshadweep 4 4 22 23 10 21 25 23 28 6
Pondicherry 241 243 233 7 23 25 24 33 24 64
All-India 93 115 61 66 52 31 54 64 72 93
Table AVI..2: Number of children with delay in attaining specified
developmental milestones per 1000 children for each state/U.T.

Type of Developmental milestones for Children of Age

1-14 Years 2-14 years 3-14 years 1-14 years 10-14 years
State / U.T.
Head Rolling Sitting Walking Talking Slow/lagging Performing Comprehending Development of Money
control behind in daily instructions speech and handling
development routine language

Andhra Pradesh 21 43 26 29 38 20 36 24 26 24
Arunachal Pradesh 253 319 146 54 125 132 206 108 107 67
Assam 155 168 206 202 194 60 153 198 121 181
Bihar 137 168 141 109 106 29 65 88 90 88
Goa 24 137 1 1 1 3 1 31 2 2
Gujarat 43 75 16 39 43 25 36 36 65 34
Haryana 31 54 19 15 45 33 46 43 45 31
Himachal Pradesh 234 185 43 66 67 16 42 82 76 28
Jammu & Kashmir 50 115 59 57 52 31 20 20 36 49
Karnataka 3 46 7 24 17 17 28 48 53 41
Kerala 20 30 17 19 18 32 15 15 35 19
Madhya Pradesh 99 132 71 77 69 18 51 49 76 44
Maharashtra 36 55 16 25 10 35 25 20 42 28
Manipur 11 39 19 19 19 3 6 5 7 51
Meghalaya 30 306 136 43 17 26 17 31 17 54
Mizoram 0 13 1 10 1 2 2 2 9 76
Nagaland 635 643 532 532 134 83 151 165 193 217
Orissa 12 8 29 21 26 21 62 76 108 76
Punjab 18 89 15 27 67 18 39 37 46 60
Rajasthan 109 140 62 87 36 25 63 59 62 25
Sikkim 182 97 147 145 21 28 150 171 79 15
Tamil Nadu 16 27 11 14 12 20 21 34 19 30
Tripura 222 218 221 224 110 18 16 57 36 361
Uttar Pradesh 140 156 73 92 46 34 38 37 50 56
West Bengal 47 60 45 35 17 39 77 73 62 65
A & N Island 33 69 57 28 25 6 16 35 76 2
Chandigarh 42 84 3 2 4 5 7 6 6 3
Dadra & Nagar Haveli - 3 24 8 - 9 7 3 108 167
Daman & Diu - - 7 3 1 4 9 28 37 33
Delhi 133 131 34 21 16 47 46 50 63 58
Lakshadweep 19 19 20 7 29 28 5 8 23 56
Pondicherry 127 155 150 7 19 12 26 9 71 325
All-India 68 90 44 48 36 29 41 44 52 46
Annexures
215
216 Community Based Rehabilitation of Persons with Disabilities

Table AVI.3: Per 1000 distribution of children of age 0-14 years by type of blood relationship
between parents for each state/UT

State/U.T. Type of blood relationship between parents Sample

Uncle-niece First Second Other No Total Children


nephew-aunt cousins cousins relationship relationship (Incl. N.R.)

Andhra Pradesh 133 67 20 160 613 1000 7235


Arunachal Pradesh 82 253 80 399 180 1000 1079
Assam 10 0 2 116 863 1000 3261
Bihar 19 3 4 92 875 1000 10506
Goa 228 94 - 37 641 1000 128
Gujarat 21 13 3 31 932 1000 3739
Haryana 3 21 0 27 932 1000 2165
Himachal Pradesh 0 0 - 25 968 1000 2551
Jammu & Kashmir 33 94 555 111 702 1000 2368
Karnataka 154 74 31 147 575 1000 4610
Kerala 3 6 12 22 949 1000 3779
Madhya Pradesh 4 2 2 88 904 1000 9962
Maharashtra 22 42 28 174 727 1000 7395
Manipur 27 3 1 155 814 1000 1093
Meghalaya 0 - - - 985 1000 1239
Mizoram 2 - 5 54 955 1000 934
Nagaland - - - 382 618 1000 728
Orissa 25 8 14 28 884 1000 4698
Punjab 0 0 1 1 997 1000 3628
Rajasthan 8 1 1 16 967 1000 5679
Sikkim - - 0 - 1000 1000 397
Tamil Nadu 207 109 26 171 485 1000 4262
Tripura 58 10 3 11 916 1000 1781
Uttar Pradesh 5 1 4 49 932 1000 17142
West Bengal 3 6 7 67 915 1000 6952
A & N Island 35 71 36 30 828 1000 1294
Chandigarh - - - 147 853 1000 181
Dadra & Nagar Haveli 5 - - 2 985 1000 305
Daman & Diu 1 - - - 996 1000 193
Delhi - - - 1 998 1000 193
Lakshadweep 0 1 - - 997 1000 300
Pondicherry 165 14 1 125 695 1000 322
All-India 38 22 10 84 838 1000 110099

Source : Government of India NSSO, 1991


Annexures 217

ANNEXURE VII

SUGGESTED ASSIGNMENTS /PRACTICAL


EXERCISES FOR LEARNING CBR

PRACTICAL EXERCISE
Practical Record for students; content of practical; developing a field practice area; suggested
exercises for students.

Sample practical Record


Schedule for practical
Schedule for postings in CBR
Development of CBR project in field practice area of each Physiotherapy College
Curriculum for CBR for Physiotherapy students RGUHS curriculum.

Practical Record may include:


Two formats each for persons with locomotor disabilities/visual disabilities/communication
disabilities/mental retardation /cerebral palsy/mental illness. The format to include aspects
of history/needs assessment/plan for Interventions and proposed follow-up measures.
The students are provided opportunities to visit at least twelve families with the above
disabilities in the field practice area. Practical may include 15 days posting in a project run
by Government or NGO or in the field practice area of the Physiotherapy college. The
students will have to fill up the standard formats referred above which are discussed by
their teachers in the field/classroom setting.

Field Visits
It is useful to consider field visits to:
• Special Schools for Visually Disabled
• Special School for Children with Hearing Impairment
• Special School for Children with Mental Retardation
• Special School for Children with Cerebral Palsy
• Normal School where Special Children are integrated

Community-Based Rehabilitation Projects*


• Community-Based Rehabilitation Project of Narendra Foundation, Pavagada
Sourabha, Samyuktha, Samanvaya, Samudaya Community-Based Rehabilitation Projects
in Mandya, Bangalore (Rural) Districts.
• Community-Based Rehabilitation Programme of Association of People with Disabilities
in Bangalore City.
______________
* List of Projects: Karnataka only. Faculty are suggested to identify CBR projects in their neighbourhood.
218 Community Based Rehabilitation of Persons with Disabilities

• Outreach Programme of Spastic society of Karnataka, Bangalore


Community-Based Rehabilitation Programmes in Gangavathi, Kolar, Yelandur (VGKK),
Hosakote (ADD India), Kaiwara (MS Ramaiah Medical College and WHO)
• JSS Polytechnique for Disabled, Mysore
• District Rehabilitation Centre, Mysore
• Canara Bank Rural Development Societies located at Harohalli and Kolar

*Arranging Interactions with Following Persons and personnel in following


institutions will be Useful to Students of Physiotherapy**:
• Visit and Interactions with District Disability Officer of the respective District
• Visit to Special Employment Exchange of the area
• Visit to Vocational Rehabilitation Centre and Interactions with staff
• Visit to NIMHANS, Bangalore and participation in child guidance clinic
• Visit to Sri Ramana Maharishi Academy for the Blind, Bangalore
• Visit to Spastic Society of Karnataka and interaction with staff
• Visit to Association of People with Disabilities and interaction with staff
• Visit to Directorate of Disabled Welfare and Senior Citizens
• Visit to All India Institute of Speech and Hearing, Mysore
• Visit to Sri Ranga Rao Memorial School for visually impaired, Mysore
• Visit to Dr. Chandrashekhar Institute of Speech and Hearing and Sunnad Kannada School
for the hearing impaired, Lingarajpuram Bangalore
• Visit to Mithrajyothi, Jeevanbima Nagar, Bangalore
• Visit to National Association for the Blind, Jeevan Bimanagar, Bangalore
• Visit to Medicopastoral Society, Bangalore
• Visit to RV Integrated School, Bangalore
• Visit to Jain Hospital and interaction with staff of Chiropody Centre and Artificial Limb
Centre
• Visit to Cheshire Homes, Opposite Manipal Hospital, Bangalore
• Visit to Mobility India, JP Nagar, Bangalore
• Visit to Workshop for people with locomotor disabilities run by Women sponsored by
Mobility India, Opposite Manipal Hospital, Bangalore
• Interactions with Persons with Disability who have achieved/made difference to
themselves/others Egg, CN Janaki, Hindustani Vocalist Sri Puttaraj Gavai, Dance troupe
of Sri Ramana Maharishi Academy, etc.
• Visit to Low Vision Centres in Manipal Hospital, St. John’s Medical College Hospital,
Bangalore
It is a useful idea to plan a study tour to these institutions, irrespective of the location
of the College of Physiotherapy.

* Similarly, faculty of physiotherapy are to identify and make a list of resource bases for CBR in the
neighbourhood of this institution.
** List from Karnataka only. Faculty are suggested to identify reasonable persons/institutions in their
neighbourhood
Annexures 219

Development of Field Practice Area


It is useful to adopt a few slums/villages and develop a field practice area by each of the
Colleges of Physiotherapy so that students can have exposure to CBR work in nearby
settings.
It is useful to consider collaboration with an NGO/disabled person’s Organisation/
Government/Philanthropic Individuals or organizations, apart from the College
Management to develop the field practice area. Development of a Community-Based
Rehabilitation park on the lines of Disabled Village Children in the Field Practice area may
be useful. Also, a visit to CBR park of NIMHANS may give ideas to develop one.
Development of field practice area and CBR park will help students of Physiotherapy
practice:
• Training Families/Persons with disabilities/ health workers/Anganawadi workers
• Develop walkers/crutches/ suitable aids and appliances
• Counseling
• Survey methodology
• Interview techniques
• Therapy – Physiotherapy/Occupational therapy/ speech therapy/Mobility training
• Focus Group Discussion/PRA
• Case Study
• Village Study
• Exposure to accessing community/Government resources.
• Development of demystified Orthotic and Prosthetic /Artificial limb centers
• Developing low cost sitting arrangements for children with Cerebral Palsy
• Development of Health Educational Material
• Participation in prevention programmes – Immunization/Antenatal Care/Under five
Clinics/Vitamin A prophylaxis/Nutrition Demonstrations, etc
• Participation in organizing therapy camps, OT and PT Camps, etc.

Developing a Library and Information Centre on CBR


Chapter 9 of the Book gives information about useful resource materials on CBR. It is useful
to develop a library procuring these materials. Some of the Useful Journals include Asia Pacific
Disability Rehabilitation Journal, Action aid Disability News, Disability World, Ability, etc.
Useful websites include:
www.unescap.org
www.who.int

Useful Research Areas in CBR


Students may be encouraged to take up field based research projects. Few select topics
include:
• Identification and needs assessment of Persons with Disability in select villages/slums
• Developing low cost aids and appliances
• Study of impact of CBR efforts
• Monitoring CBR practices
220 Community Based Rehabilitation of Persons with Disabilities

• Training Health Workers


• Training Anganawadi Workers
• Training Teachers
• Training Family Members
• Training Volunteers
Index
A sampling plan 82 indicators of 37
time frame 84 intersectoral coordination,
Affirmation action 153 use of data 84 rehabilitation 21
Assessing, person with disability 124 format for case study 85 levels of prevention 16
government programmes 43 needs concerning disabled
B initiating CBR activities 64 people 13
initiatives operational premarital counseling 20
Basic principles, CBR 45 guidelines, beneficiaries in prevention of 14
166-170 prevention, consanguineous
analysis of data 168 marriages 20
C guidelines for translation of public health programmes 16
Call for action 211-213 proformae 170 questionnaire, identification of 31
central and state governments interventions 169 specific causes for 10
211 personnel and field level types/classification of 11
corporate sector 212 activities 167 childhood 209
International agencies 212 institution-based rehabilitation 42 hearing 203
media 213 knowledge 60 locomotor 204
NGOs 212 linkages and alliances for 134 speech 204
public 213 organisational case study 47 visual 203
support institutions 213 outreach programmes 43 UNESCAP reports 38
Community-based rehabilitation planning, implementation of 58 UNICEF’s perspective 38
(CBR) 41, 4 practical exercises for learning universal salt iodisation and
approaches for public health 59 217 challenges 18
educational approach 59 pre/post evaluation 59 vitamin A prophylaxis
legislative approach 59 preliminary steps in initiating 30 programme 18
service approach 59 programmes, list of 90 Disability in India, magnitude of
approaches seen in India 43 RHR consortium monitoring 81 problem 121-123
appropriate technology 62 role of a physiotherapist 133 International consensus 121
attitude and practices 60 skill transfer 60 National trust act 123
basic principles of 45 starting, CBR programme 46 organisational case study 123
camp approaches 42 training 62 suggestions, plan of action
case study 67 122
challenges 43
demystification attempts 61
D
E
evaluation of 74 Development, Indian children in 39
conceptual areas in 77 adaptive and socio-cultural 39 Employment 129-131
parameters of 77 cognitive/developmental disabilities, seeking jobs 129
qualitative methods of 78 assessment tools 39 open employment for
quantitative methods of 78 motor and language 39 disabilities 131
evaluation tool kit 81 Disability 7 self-employment for disabilities
focus group discussion protocol 81 causes of 8 130
analysis plan 84 CBR and primary health care 21 sheltered employment 131
data collection guide 82 efforts, government of India 15 women with disabilities 130
data collection procedures 83 efforts, UNICEF and WHO 15 Evaluation 76
dissemination 84 filariasis, disability prevention 20
ethical considerations 81 immunization schedule 16 H
facilitator characteristics 83 implementation, prevention
facilitator training 83 programmes 19 Hansen’s disease 30, 202
222 Community Based Rehabilitation of Persons with Disabilities

I central coordination committee disabled peoples


140 organisations (DPOs)
Integration 12 commissioners for disabilities 115
159 district rehabilitation centres
L education 149 103, 112
employment 151 economic assistance for self-
Legislations 117 institution for persons with employment 103
Act and promulgation 119 severe disabilities 158 education and training 101
Disability act of 1995 118 miscellaneous 163 employment 102
Employees state insurance act, non-discrimination 154 fellowships 101
1948 118 preliminary 137 funding support 98
Indian factories act, 1948 118 prevention and early detection International NGOs 115
Obstacles, implementing, of 148 legislations 113
disability act 118 recognition of institutions for major schemes 106
Salient features, act 119 disabilities 156 National awards 103
research and manpower NGOs 108
M development 155 other facilities/concessions
social security 162 104
Methodology for training 23-28 state coordination committee reservations 103
identify children in 25 144 resource institutions-
difficulty in moving 25 Prejudice to dignity 5 government 107
difficulty in seeing 25 Proforma 172-201 special employment
epilepsy 29 assessment of disabled persons exchanges, list of 109
hearing problems 26 187 useful websites 115
leprosy 30, 202 blank format, analysis of vocational rehabilitation
questions for use 23 survey data 197-201 centres 102, 111
in assessing a person, community profile survey 172,
disabilities (WHO) 24 179
in identifying people, S
scheduling activities for survey
disabilities (WHO) 23 196 Skills training 128
screening schedule for mental Special education 4
retardation 28 Supervision 75
Monitoring 75 R Surveillance 75
Rehabilitation 1
O Rehabilitation manager, attributes V
of 134 Vocational assessment 128
Occupational therapy 5 Resources for 89 Vocational rehabilitation 127
Organisations in India, list of 95 CBR 89 Vocational training 4
disability rehabilitation 89
programmes, mentally ill 98
P aids and equipment for the W
Persons with disabilities act, 1995 disabled, list of 114 WHO, list of publications 89
137-163 bilateral/multilateral
affirmative action 153 agencies 114