Sandhya A Singh Director: Chronic Diseases, Disabilities and Geriatrics Department of Health

Implementing Rehabilitation Programmes: Briefing to the Joint Monitoring Committee on Improvement of quality of life and status of Children, Youth and Disabled Persons.

Sandhya A Singh

Director: Chronic Diseases, Disabilities and Geriatrics

Department of Health

30 May 2008

Introduction Access to health care creates equalization of

opportunities. Comprises various components including

rehabilitation. Prevention is integral – all levels Rights-based service delivery Barriers experienced are noted Persons with Disabilities are within health

system Implement policy to improve quality of lives.

The outline of the presentation..

Underlying policy Policy must benefit those in greatest need Disability and rehabilitation exclusion Comprehensive rehabilitation service DOH creating access to rehabilitation

services Barriers are noted Conclusion

Legislation and Policy underlying service delivery…

National Context National Health Act (No 61 of 2003) Mental Health Care Act (No 17 of 2002) National Rehabilitation Policy Free Health Care Disabled People at Facility

Level. Child Youth and Adolescent Mental Health Care

Policy Guidelines. INDS (1997)

International Context….U N Convention on the Rights of

Persons with Disabilities Translate into the proposed National

Disability Policy Framework Articles

Cross Cutting eg Prevention, Access to Information

Health, Rehabilitation and Habilitation.

Policy must access those in greatest need….

DOH recognizes a rights-based definition Supports the Cabinet proposal (1995)

Disability is the loss of opportunity due to barriers

Compliant with the ICF

2001 Census – “Reported impairment” Impairment based How do we measure barriers?

In attempting to benefit those in need…..

Disability results in further Exclusion … Poverty

Difficulty accessing basic services in general. Difficulty accessing rehabilitation Vulnerable to disease

Women Mothers or caregivers With disabilities

Low levels of literacy

Comprehensive Rehabilitation……

Various levels of preventionGoal-orientatedTime limited processEnable person to reach optimal

functioningSocial integration

CBR is a Philosophy first…

Based on CBR as a Philosophy Person with Disability/Family and/or

Caregiver is central to all decision making processes

Rehabilitation occurs “with” and not “for” NDPF recommends the development of inter

sectoral policy on CBR

What comprehensive rehabilitation includes….?

Primary Prevention General Public Information must be in an accessible mode and

format Healthy lifestyles Prevent Onset

Secondary Prevention Early Identification and Intervention

Referral sytems ECD

Inter Sectoral Collaboration

Comprehensive rehabilitation….

Tertiary prevention – Rehabilitation Inter sectoral and Multi-Disciplinary All levels of care Provision of Assistive

Devices,Technology,Surgery Provinces vary in terms of their capacity to issue Eg – November 2007

Gauteng 1717 manual wheelchairs

Eastern Cape 1453 wheelchairs

Changing profile observed…

Increasing demand from persons with acquired impairment and disabilities HIV and AIDS

Neuro-anatomical,sensory Diseases of lifestyle

Stroke Diabetes related

Amputations Blindness

DOH creating access to rehabilitation toward improving quality of life…..

DOH Strategic Plan 2008/09-2010/11 Free Health Care at Facility level Accessibility of health facilities

Physical Communication Access – point of public transport to facility

Waiting period for wheelchairs

Policy Orientation and Mobility Services

Creating Access…..

Intra Sectoral Collaboration eg: MCWH

Foetal Alcohol Syndrome Care and Support

Step down Facilities Geriatrics

Rehabilitation @ old age homes Facilities Planning

Building accessibility

Access….. Inter Sectoral Collaboration

DOE Collaboration on implementing WP 6 ECD

DOSD Disability Grant Assessment ECD

RAF Propose that assessment tool for serious injury is based

on the concept of ICF – impact of injury

Access…..

Information/ Education SABC/ local radio education programmes Basic sign language and interpretation training for

health service providers Provinces exploring training of Deaf persons as

VCT counselors Making HIV &AIDS education accessible to all.

Community Service for therapists Access to services by many communities for the

first time.

Access….

Economic Development Persons with Disabilities to repair

wheelchairs Located at wheelchair repair sites Receive remuneration in various forms

SLAs with NGOs Paid directly

When there are barriers to access…

Within the health system Services at a local level? Lack of or limited resources

Recruitment & retention of Therapists Transport to reach patients in the community Budget

Assistive Devices/ Other technology Consumables – Nappies, linen savers

Barriers…

When resources exist.. Limited space available Provincial budget system

Centralized vs decentralized

Difficulty to sustain NGO initiated – integrate into the health system

“priority” competing with other programees Difficulty to apply systems to rehabilitation – seen

as something different outside health

Barriers…experienced by the person

No support/assistance Children Adults and older persons who are not

independently mobile. Public Transport

Cost Basic availability

Models of service delivery are inappropriate “do for” CBR – common Understanding???

Thank You.

Sandhya Singh

SinghS@health.gov.za

Cell 0828825012

Tel (w) 012 312 0472/3

In conclusion…. Rehabilitation often provided under very difficult

circumstances Rural doesn’t mean poor quality Commitment by service providers must be

recognized. HOWEVER!

Recognize GAPS! Accessibility to rehabilitation by all communities-EQUITY

Assistive Devices/technology Reinforcing Human Rights approaches

Strive to create optimal environment We must work together.