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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. - PowerPoint PPT Presentation
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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???
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.
