Unit 4: Community for Disability Rehabilitation

4.1  Concept and types of communities

4.2  Role of community in prevention early identification, and intervention of disability

4.3  Community based inclusive development – need, importance and strategies

4.4   Creating enabling environments- mobilising local community resources towards the rehabilitation of persons with disabilities.

4.5  Issues and challenges in rehabilitation of child with disability in the community

 

 

 

 

 

 

 

 

 

 

4.1           Concept and types of communities

 

The Meaning of Community:

The social life of the people is affected by the kind of community in which they live.

It was defined as an area marked by the sentiment of common living. It includes (a) a group of people, (b) within a geographic, area, (c) with a common culture and a social system, (d) whose members are conscious of their unity, and (e) who can act collectively in an organised manner. In the concept of community the two basic elements are those of a geographic area and sentiment of unity.

The Community as Locality:

The community is a territorial group which shares a common soil as well as shared way of life. II is no accident that people concentrate at a particular place and cluster together. Nearness facilitates contact, furnishes projection and makes easier the organisation and integration of the group. People living in the same locality come to have a distinctive community life.

Once a group of people gets sallied, an element of space enters into the social relationship. Local groupings become more important than even blood relationship. People who live in the same locality though they belong to different bloods, form a community. Even an immigrant who does not belong to kinship may become a member of the local community.

An important aspect of the physical structure of the community to which attention may be drawn is its unplanned physical structure. No long-range preconceived plan stands behind the different areas of modern community, the village, the city and the region. The result has been congestion, use of physically deteriorated habitations and other buildings, unbalanced development of various areas of living and of business activity.

The Community as Sentiment:

Community is more than the locality it occupies. It is also sentiment. The people living at a common place and leading their lives in one another’s company come to develop ‘we-feeling’. The place they occupy is to them much more than a portion of earth’s surface-it is their ‘home’. Living together makes them share common memories and traditions, customs and institutions.

It shapes their attitudes and interests. The sense of community becomes impressed in the depths of their personality. The community sentiment becomes a part of his own individuality. The individual identifies his interest with larger interest of the group. He feels indissolubly bound up with it so that to him the community is “bone of his bone and flesh of his flesh”. He carries a sense of dependence upon the community, which is both physical and psychological since his material wants are satisfied within it and since it sustains him and provides him solicitude.

There are, broadly speaking, five different types of communities.

You can classify every type of community by the purpose that brings them together.

1.     Interest. Communities of people who share the same interest or passion.

2.     Action. Communities of people trying to bring about change.

3.     Place. Communities of people brought together by geographic boundaries.

4.     Practice. Communities of people in the same profession or undertake the same activities.

5.     Circumstance. Communities of people brought together by external events/situations.

 

Types of Community in Sociology

There are two types of communities Rural and Urban communities, due to different social conditions in both rural and urban areas.

Rural Community

Rural community is a natural phenomenon. It is present in every society of the world having distinct culture and pattern of social life. It is actually a product of natural free will of the people having extreme similarity in their objectives and ambitions of living. Agriculture is the main identity and element. People of this community mostly have. Face to face ‘interaction with high degree of homogeneity in their identities. Basic urban facilities like school, hospital, market, municipal office, police station etc. are usually missing in this community.

Urban Community

Urban community is the opposite of rural community. The urban people lifestyle are highly impersonal with each other along high degree of complexity and heterogeneity in their living style and identities. It is actually a product of rational choice. A complex division of labour with specialization in their jobs is the identity of urban community. Modern civic facilities are usually available.

Suburban Community

The suburban areas are the mix of the urban and rural. With a suburban area, you are going to get many of the same conveniences a city has. You will also get room to spread out and move around as well as a bit of nature. Many communities across the world are built in suburban areas. This allows people to travel into the city if they need to for work and then return to the suburbs at night and on the weekends. In the suburbs, you usually see quieter streets with houses lining them. There are parks, lots of schools, and generally some small towns as well.

 

 

4.2           Role of community in prevention early identification, and intervention of disability

 

The term ‘community’ embodies the importance of each and every member including the disabled individuals as we have witnessed that the existence of a community can allow greater change amongst the people coming from any race, culture, background and religion. In order to bring light to the subject, we must be able to comprehend the dynamics of the terminology; Community. It exists due to the basic fundamentals and the mutual understanding of people including norms, religion, identity and values.
As Albert Schweitzer, a French-German theologian quoted:
“The purpose of human life is to serve, and to show compassion and the will to help others.” Fundamentally, it is our vital duty to allow others to find comfort, show affection and serve every individual with or without special needs. Moreover, a positive approach within the community inherits a productive and drastic phenomenon which will therefore be engraved for the coming generations.

The role of a community towards the disabled individual can be easily elaborated if we emphasize on creating friendly relationships with pure intent and understanding. First of all — the importance of forming a bond has hence permitted the individuals to collaborate and empathize with the disabled individuals which thus automatically creates a sense of worth and belonging. In contrast, a distressed disabled individual won’t be able to be productive if he/she is left alone so therefore, building a connectivity bridge will lead to finding out the similarities and the differences of each and every individual within the community. 

If we define disability as the interaction of a person's "physical or mental limitations with social and environmental factors" (Pope & Tarlov, 1991, p. 1), then most disabilities are preventable. In the specific area of mental retardation, Drash (1992) points out that 80 to 85% of all cases could theoretically be prevented. This is an idealistic goal since improved social attitudes, better community accessibility, environmental clean-up, and the elimination of poverty would all be required for its attainment.

The goal of total prevention of disabilities raises a major ethical question: to what extremes are we, as a society, willing to go to prevent handicaps? Enforced sterilization for anyone believed to carry defective genes might prevent some disabilities, but would it be ethically acceptable? Prenatal diagnosis of some conditions such as Down Syndrome is now possible. Should this evaluation be mandatory and abortions performed whenever an affected fetus is found? Some people seriously advocate these approaches to prevention (Pueschel, 1991).

Disabilities caused by injury are also, theoretically, completely preventable. The reality is that some accidents will happen, no matter how careful, or well-informed, the population. Accident related injuries are a major area for preventive efforts. If the injury rate here is similar to that in the U.S., 5 million Canadians would be injured each year; of these, about 130,000 would have head injuries and 7000 would suffer "moderate to severe traumatic brain injury" (Pope & Tarlov, 1991, page 12).

Many developmental disabilities are totally preventable. All those which are associated with pollutants can be prevented through environmental clean-up. Developmental delay due to deprivation would not occur in a society that provided a nurturing environment for all its children.

The role of a community towards the disabled individual can be easily elaborated if we emphasize on creating friendly relationships with pure intent and understanding. First of all — the importance of forming a bond has hence permitted the individuals to collaborate and empathize with the disabled individuals which thus automatically creates a sense of worth and belonging. In contrast, a distressed disabled individual won’t be able to be productive if he/she is left alone so therefore, building a connectivity bridge will lead to finding out the similarities and the differences of each and every individual within the community. 

The common ideology of all these platforms is to provide a sense of belonging for the disabled individuals where they can share their real life experiences online in a safe, comforting and friendly environment.

One of the major step towards a collaborative community is to be provided with trained teachers taking the responsibility of engaging the disabled individuals. The importance of a trained teacher is substantial in an inclusive education and the necessity of achieving better results by filling the space for the disabled individual with knowledge and a sense of recognition. The right training of the teachers should not be overlooked by the authorities but instead encourage the trainee/trainers to participate in professional development courses. Hence, teachers are the pioneers of a community in building a common ground for the individuals facing any disability. Thus, with their training, the disabled individuals can succeed and shine in any desired platform.

 

 

4.3           Community based inclusive development – need, importance and strategies

 

CBID is an approach that brings change in the lives of people with disabilities at community level, working with and through local groups and institutions. CBID addresses challenges experienced by people with disabilities, their families and communities in practical ways. For example, it offers opportunities to join community based self-help groups and livelihoods activities. The approach embraces diversity across multiple and intersecting categories of identity. In the current context and drive for localisation of the 2030 Agenda for Sustainable Development (SDGs), CBID is increasingly relevant. 

CBID programmes can include health, education, livelihood, social and empowerment activities, working closely with local partners, local governments and the disability movement to bring about change. CBID particularly promotes the participation and voice of people with disabilities in decision-making processes at the local level. In high risk areas, CBID programmes include activities that address community preparedness and resilience for when natural and human-caused disasters strike. CBID enhances and strengthens earlier work described as Community Based Rehabilitation (CBR) and encourages more inclusive, responsive and accountable communities. 

CBM has a long history and a solid reputation in CBID, having influenced the evolution of inclusive community development over decades and at a global scale. Our CBID work is guided by the principles of the CRPD. It recognises that building strong communities requires a focus on equal access to good quality services and on civic participation aimed at supporting and working with people with disabilities, their families and organisations, to fully participate in the social, economic and political life of their communities. Thus, CBID is an essential contribution to CBM’s Vision of an inclusive world in which all persons with disabilities enjoy their human rights and achieve their full potential. 

Launched recently by the Union Ministry of Social Justice.

Features:

1.    The program aims to create a pool of grass-root rehabilitation workers at community level who can work alongside ASHA and Anganwadi workers to handle cross disability issues and facilitate inclusion of persons with disabilities in the society.

2.    The program has been designed to provide competency based knowledge and skills among these workers to enhance their ability for successfully discharging their duties. These workers will be called ‘Divyang Mitra’ i.e. friends of persons with disabilities.

3.    The National Board of Examination in Rehabilitation under the Rehabilitation Council of India will conduct examinations and award certificates to pass-out candidates.

 

 

 

4.4         Creating enabling environments- mobilising local community resources towards the rehabilitation of persons with disabilities.

 

Community mobilization is the process of bringing together as many stakeholders as possible to raise people's awareness of and demand for a particular programme, to assist in the delivery of resources and services, and to strengthen community participation for sustainability and self-reliance. A lot can be achieved when people from different parts of the community share a common goal and actively participate in both identifying needs and being part of the solution. Community mobilization helps to empower communities and enable them to initiate and control their own development.

Little progress will be made towards mainstreaming disability until community support is built up and the different sectors of society become actively involved in the process of change. CBR programmes can use community mobilization to bring together stakeholders in the community, e.g. people with disabilities, family members, self-help groups, disabled people's organizations, community members, local authorities, local leaders, decision- and policy-makers, to address barriers within the community and ensure the successful inclusion of people with disabilities in their communities with equal rights and opportunities.

This element focuses on how CBR programmes can bring people together to act and bring about change in the communities in which they operate.

Mobilize and manage resources

Financial resources

Fundraising: It is essential to seek financial resources for the development of new programmes or to enable existing programmes to continue their work. Finance for CBR programmes may be mobilized from many different sources. Where possible, the emphasis should be on community-based funding, as this will contribute to the longer-term sustainability of programmes. Possible sources of funding in the community may include:

If sufficient resources are not available locally, fundraising may be required at regional, national or international levels to develop and implement CBR programmes.

Financial management: It is important to establish a transparent system for managing finances. This will ensure that the programme is accountable to stakeholders, including funding bodies, community members and people with disabilities themselves. Financial management is a key role of the programme manager, but others may be involved, particularly when programmes are large and involve large amounts of money. Financial management involves:

 

Funding and sustainability financial support to the programme is provided by the Royal Government of Bhutan and WHO. Under the decentralization policy of the government, all developmental activities and programmes to be implemented in communities are now decentralized. Funds from the central programme are released for implementation at districts by the district health officials

Accessibility

 This is one of the major areas addressed in the CBR programme. If there are accessibility issues related to public buildings, toilets or houses, a certain amount of funds (depending on the problem) is dispersed by the National Fund from the Ministry of Social Services and Social Welfare. Community contribution is expected in the form of voluntary labour. This increases community ownership and ensures sustainability. Amendments to Disabled Persons (Accessibility) Regulations, No. 1 of 2006 are also under way. Several awareness programmes are conducted on access to public buildings and places to create awareness among government institutions at district, provincial and divisional levels.

Community Participation 

The new partner agencies already had acceptance and credibility in the community for other services given. The community became interested in the additional services and became involved in identification and motivation of the visually impaired in accepting services. The community leaders, who were impressed by the visibly dramatic improvement in mobility, daily living and social skills developed by the visually impaired, actively assisted in obtaining other facilities and concessions from the community, Government and financing organisations, all for the improvement of economic rehabilitation for the visually impaired. The process also involved gifted clients as motivators and facilitators, advising families of the visually impaired, community leaders and other rural service organisations in NGO and occasionally Government sectors.

As part of the project development, refresher courses were organised periodically for one week or two week durations. The participating agencies were encouraged to contribute to the agenda by sharing case studies, special aspects of their areas and specific and common difficulties. The refresher courses were planned to be interactive so that issues and projects were analyzed and solutions evolved. The nearby Government officials, blind welfare organizations and eye care institutions were also invited as guest faculty.

Strategies and role of government in promoting participation in CBR

 

In order to improve and strengthen implementation, the Government must set up management structures to facilitate the smooth operation of CBR programmers’. This includes policy-making and planning, appropriate administration structures, provision of resources, decentralization, training personnel, onward referral systems and monitoring and evaluation.

 

Policy formulation, review and promotion

 

Today, various governments have laid down a number of strategies to promote participation of marginalized groups. Governments have policies applicable to vulnerable groups in general, but there is a need to design policies, which adequately address issues of PWDs. This may require formulating new ones, promoting or reviewing existing ones, so that any deficiencies in particular sectors such as health services, schooling and employment opportunities that affect PWDs are corrected. By formulating a detailed policy statement, the government points out what is to be achieved, how to implement change, who is responsible, when can change be made and a commitment to provide the resources. In Uganda, the affirmative strategy has been used to promote participation.

 

Putting up appropriate administrative structures

 

The Government has set up the necessary structures to ensure Community participation in CBR programmes. This includes the Department of Disability and Elderly in Ministry of Gender, Labour and Social Development to coordinate disability issues. This Department has also set up a National CBR steering Committee, which consists of the key stakeholders to monitor the activities of the CBR programmes. Due to decentralization, a similar structure has been duplicated at district and lower levels.

 

Mobilization of resources

 

Funds, personnel, equipment, transportation, physical structures, statistical services, research and information are some of the resources that have to be mobilized. Central and local government bodies, communities and non-Government organisations provide these resources. The government role here is to identify with the communities the available resources, and to point out to the community what it has to do, such as, provide local management and some of its resources. The government can then fill the missing components through training, technical supervision, administrative support and referrals.

 

Decentralizing to encourage community participation

 

One of the key features of CBR programme development is decentralization. However, this in itself is not enough, as there is no guarantee that this process can lead to higher levels of participation in the community based rehabilitation programmes. Decentralization must be followed by a change of attitudes.

 

Training and sensitization

 

This component is important, for building a competent workforce at all levels. In Uganda, training of CBR workers is carried out at UNISE,COMBRA and Makerere University (Makeree University 1994). Sensitization is another key activity. All stakeholders have been involved insensitisation of technical personnel.

 

Building and maintenance referral options

Referral options are looked at as places where PWDs can be referred for treatment, education, employment and legal advice. In most cases, these cannot be handled by communities, so it is the role of the government to ensure that these services are operating efficiently.

 

Monitoring and evaluation

The Government monitors and evaluates the progress of all the programmes relating to people with disabilities. This serves as a check and contributes to the quality of the programmer’s development. High levels of participation are encouraged and where this is not achieved, action is taken to increase the level of participation and the range of stakeholders involved.

 

 

4.5           Issues and challenges in rehabilitation of child with disability in the community

 

CONSTRAINTS

 

Inadequate funding

 

The Government would like to extend the CBR programme to the whole country, but due to inadequate funding, CBR is still limited to 10 out of 56 districts.

 

Lack of statistical data

 

The magnitude of disability prevalence is not known due to lack of reliable data. It is hoped that the next Population and Housing Census will come up with better disability statistics for ease of planning and resource allocation.

 

RECOMMENDATIONS

 

Empowerment

 

Even though some measures have been undertaken by the Government to eradicate poverty among PWDs and promote access to employment, this is an area, which still needs greater focus. For example, more PWDs need accessibility to micro-finance schemes in the community. Through this, the government will have ensured that PWDs are engaged in productive ventures for an improved standard of living. There is also a need to promote cultural values and languages, including sign language, which is used by the deaf to preserve and enhance dignity of all.

 

Gender balance

 

Emphasis should be laid on gender balance, fair representation of disadvantaged groups and a call for society to respect the rights of PWDs, particularly the girl child and women. There needs to be better educational opportunities for the girl child, whether she is able-bodied or not.

 

Health care system

 

Since the leading causes of disability are communicable and preventable diseases, an improved health care system is a pre-requisite for reducing the rate of disability.

 

Removing physical and environmental barriers

 

The Government should be able to be more vigilant and avoid activities that increase disability, such as wars and motor accidents. Laws should be enforced to punish careless drivers and those involved in domesticviolence. Work places should be conducive to productivity and repetitive straining influences should be avoided.

 

Institutional rehabilitation

 

Everyone is well aware that community based rehabilitation does not provide all skills to PWDs. There are those who are severely handicapped, and, who still need the services of institutions. Governments should therefore continue to fund Institutions, so that they work hand- in- hand with the CBR programmers'.

 

Coordination

 

As has already been discussed, CBR is implemented by different stakeholders. In order to avoid duplication, the government should be able to coordinate the activities together with the stakeholders and monitor and evaluate them.