Search Destination : Community Based Rehabilitation (CBR)
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SEARCHING DESTINATION
2.066
A Report on Community Health Experience
Community Health Fellowship Scheme
Conducted By :
Community Health Cell, Bangalore.
Supported by :
Sir Ratan Tata Trust, Bombay
From August 2006 to February 2007
Chief Mentor
Dr. Thelma Narayan
By
Juned Kamal
Community Health Fellow
Bhopal (M.P.)
Field Mentors
Dr. Ravi D’Souza
Dr. Yogesh Jain
(Jan Sawasthay Sahyog)
Bilaspur, Chhatisgarh
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Contents
S.N.
Topics
01
02
03
04
Acknowledgement_______________________
Executive summery______________________
First month orientation.___________________
CBR Report
• Introduction
• An understanding of Community Based
Rehabilitation
• Introduction of /CBR forum.
• CBR experiences in the field: planning,
monitoring, capacity Building, and
evaluation of CBR programmes in the
field.
• Advocacy
• Persons With Disability Act 1995.
• Learning’s and suggestions___________
JSS Report
> Learning objectives
> Health workers training
> Scabies survey
Introduction of the study
Village information
Why study done
_____ Information about scabies___________
Other Activities
> ISA Meetings (NCC, State )
> MFC / AIDAN
> ISF______________________________
Learnings / Conclusion
05
06
07
Acknowledgement
First of all I would like to express much indebted thanks to my almighty “Allah”
to giving me this opportunity to explore in the way of serving people, and guided
to fulfill this objective through this fellowship scheme.
I am heartily indebted to Dr. Thelma Narayan and Dr. Ravi Narayan and all the
staff team of the CHC for providing me an opportunity to explore according my
learning objectives in Jan Swasthya Sahyog Ganiyari, and the CBR Forum
Bangalore. Through their rich experience and guidance it was possible for me to
complete this project successfully.
I am also, thank full to Mr. Nicholas Guia Rebelo, Director, CBR Forum for
giving me an opportunity to learn different dimension in CBR concept. During the
entire period of my project activities, he and his team has been rendering their full
support and guidance from the initial stages to the end of this project.
I would like to express my gratitude to Dr. Ravi D’souza who motivated me to
explore in JSS. Dr. Yogesh Jain Dr. Anurag Bhargav for their continuous guidance
and support during the study of scabies and entire the JSS team specially village
health team who helped me a lot to understand the rural realities which were
helpful for me to complete study.
The thanking is not complete if I do not appreciate the support of village health
workers and the habitants of Davanpur and JakadBanda, persons with disabilities
their family member, and the community. Without their involvement it would
have not possible for me to complete these projects, I thank them from the depth
of my heart for allowing me to understand and learn the challenges in
rehabilitation through the community based mode.
I dedicate this entire project to my Parents, Family members and Friends for their
encouragement and support to complete this project.
And in the last I will close this chapter by the words that “if the necessity is the
mother of Invention”, then “the experience is the mother of memories”. And I
extremely thankful to all the persons who have directly and indirectly contributed
in these experiences, that will be with me in my memory lifelong.
Juned Kamal
Executive summery'
I am quite happy to present this report as a community health fellow of
Community Health Cell Bangalore. This report is about my field experience
of six months which I spent in different development organizations and
groups it is contain my reflection, based on the experience which I got
through the field visits and grass root level work experiences in different
places.
The contents of the report are Community Based Rehabilitation of Persons
with Disability, field experiences in Jan Swasthya Sahyog (JSS), Indian
Social Forum, ISA NCC, state level meetings, and AIDAN / MFC meetings.
These visits helped me to explore at, different levels and to understand the
different dimensions of community, community health and public health.
During these six months I got a chance to get exposure in the selection and
training of Community Health Volunteers, in JSS. (Chhattisgarh).
Beside these activities my other learning objectives were study of PWD Act
1995, in CBR Forum, and the study on prevalence of scabies in rural Bilaspur
District (Chhattisgarh). The study is still in on going and the second part of
my study, which is the treatment of scabies in rural areas, will be done by the
end of this month (February 2007).
These six months period helped me to learn or thing about national and
international issues like globalization, privatization, and market economy,
that is directly or indirectly affecting health of the communities and public
health services along with the primary care. Essential public health is being
privatized. The main objective of these services were to serve the
community, but the anti people policy are changing the irrational drug policy,
lack of budget for the health and education, corporate led globalization and
industrialization, are decreasing the Govt, control over health.
I didn’t do many things which I thought I would do, as I got exposure in new
areas.
And now at the end of this fellow ship programme, I am confident and have
learnt a lot. Every thing that I experienced here brought new learning’s for
me, perhaps I have gone through was new for me.
t HI
ifa
First month orientation
First Week
Form 6,h to 11 August 2006.
1
2
3
4
5
6
6
First learning*^
Health
Community health
Public health
Primary health care
Health situation of India.
Struggle for Rs. 100/-
Report for the month of August 2006, CHFS orientation.
From 7 Aug. 2006 to 8 sep. 2006
After being selected for the Community Health Internship programme in
Community Health Cell Banglore, our first session started at 9:30 am on 7
August 2006. This was the first month, of the six months fellowship
programme. During this month we went through the various aspects of
Health, Public Health, community health, Primary health care services, the
people health movement, and we also went to the field to visit various
programmes.
I am starting the very first day of the orientation class. I am including only the
important points that I noted during the orientation.
From 07 to 12 Aug.2006.
The very first day we introduced over selves with each other, and with other
CHC team members, with their work responsibilities. The first thing that is
used in the social or community work is a team spirit, and to know about
others; Sincerity towards learning’s it is a process to enhance individual skill,
it is a participatory learning method through we share the information, and
learn together by discussion in light of own experience.
2
The next day 8 Aug. 2006 after looking back we got introduced to the
concept of health. In this session Health, Public health, Community Health,
Primary Health Care were discussed with its broader view.
We learnt that;
Health - is not only the absence of the disease, but well being of social,
economical, cultural, political, spiritual, and mental conditions.
Public Health — is whatever the services are providing by the govt,
like — sanitation, water for daily use, light, housing, safe drinking
water, employment, primary health care, etc. are concerned with the
public health. This is the prime responsibility of Govt, to assure all of
these services for community. It is the organized of a society for health
through government, voluntaiy organiations and civil societies etc.
Community Health - is a process to involve the community to take up
responsibility in providing services for their own health, and demand
health as their fundamental human right.
In this process of Community Health, communities come together, set
their priorities , demand for services according priorities, and after
getting it, they take the responsibilities to monitoring it. These services
could be education, primary health care, agriculture, sanitation, safe
drinking water, etc.
Primary Health Care - is many peoples, organizations, and
institutions were working for primary health care (basic health care) by
1970’s,besides the definition of WHO on health after the Alma - Ata
the idea of Primary Health Care came as a revolution.
In the Alma - Ata (1978), primary health care defined. It recognized the
limitations of medical science and emphasized on the need to address
the determinants of health. It emphasized the need for equity and social
justice in health and health care services. It emphasized the greater
decentralization and involvement of local habitants in decision making,
planning, implementation, and monitoring of health care system and
services, according to the social economical, political and cultural
conditions.
It gave the four key principals
1
Equity - this could be gained through the equal distribution of
health resources and services.
3
2
3
4
Community participation - through community will be
responsible for their health, whether it is Public Health or
Community Health.
Intersectoral coordination - the different department of govt, that
are working in the field of public heath like, NGOs of the
developmental field, and other civil societies workers and
corporate, will ensure the development through their mutual
cooperation and coordination, and these development will be
responsible for good health of the community.
Appropriate technology - should be used for the primary health
care in place of high and more advanced technology. It should
not depend on what we want to provide, but it depends on
according to peoples need and priorities, what they want and
what will be applicable their.
It was just like a movement to turn medical care into primary health
care.
Here are various components of primary health care that try to ensure
health for all, by these components up to some extent primary targets
could be achieved.
Education, concerning health problem and about methods of
identifying, preventing and controlling them.
Promotion of food supply and proper nutrition.
Adequate safe drinking water supply and sanitation.
Mother and child services.
Prevention and control over locally epidemic diseases.
Provision of essential drugs.
Availability of local health workers.
Identifications of local health traditions, and locally available herbs
and their proper use.
Beside all of these services we should know to whom , we are going to
provide these services, so that history of the community and society
must be understood, Bharat Darshan by slide show help to understand
the various communities of India.
Followings are the learning’s
Bangladesh refugee’s camp shows the lack of primary health care
services and horrible picture of war and conflicts and its bad effects
on human health.
4
- Gandhi ji’s charkha shows that we are all from working class, we
have hard work and labor and keep away all the disease away from
us.
- Our tribes who are living in the out reach areas are quite near with
the nature happy, and healthy them self, they have their own
treatment systems with the herbs, but the migration and
development are effecting their health and life as well.
- It focuses on primary health care services that should be reach to
community according to them. Health for all not only concentrates
on primary health care but also consider that social economical,
political, and cultural factors in the community are the determinants
of health. These factors make us enable to understand the root
causes of ill or bad health. It makes us enable to understand medical
aspects, under the light of SPEC aspects.
i.e. for the like malaria and other vector borne disease not only
mosquitoes are responsible, but our living conditions, sanitation, water,
unhygienic food, traditional system, lack of awareness, education
migration, etc. all factors are together responsible. So in addition to
treat the disease, the treatment of all of above factors is also importent.
These factors were looked in the case of Mahila Jagruth
Sangathana,(JMS) Raichure district.
The title of story was The struggle for Rs. 100/-, this is a responsibility
of the govt, by the law and as public health provider to ensure the
pension for elder persons of the society. But only to get this help they
being exploited automatically, as economically - by traveling many
times to complete formalities, and wage loss, politically- by
beaurocracy, bribe, by Gender - women are not allowed to go out side
alone, giving preference to men, in housing, cant raise voice for their
rights, and by culturally - social systems, customs traditions & beliefs
etc.
Health situations in India As primary health mentioned before, that it is a fundamental human right
and health and Education are the subjects of the state, so that following
two things are important 1_ Awareness in the community about public health community health
and primary health care services
2_Equity in health
5
- Health care services should be accessible to all especially to the
disadvantaged and marginalized groups of the community
- Applications of resources based on peoples need.
- Reduce the disparity in health and health care services.
- Health care utilization and resource allocation.
Our health care services are getting commercialized and more and
more corporate sectors are being involve in health system and making
profit, and planning to increase it.
In India
more then 75 % - private health care
25 % - Govt. Health care
There are only 270 essential drugs declared by WHO, but more then
80,000 brands are available in the market. Too costly, inappropriate,
delayed, treatment, essential drugs are not available, if available due to
cost not affordable. All these factors are keeping away to health care
from the approach of a common man. Health and education budget is
continuously being deducted; corporate sectors are looking here the
opportunities for the investment. In every time Govt, set the goals
2
2
4
Programme______________________
Eradication, Polio________________
Eradication - Leprosy_____________
Zero level growth of HIV/AIDS
TB, Malaria, and other vector bom
diseases
Goal
2005
2005
2007
2010
But since 1982 only some health goals was achieved but a long list of
targets are still not achieved. At the time of independence India and
China has same economic conditions but after 53 years of
independence we find a huge gape in both of the economies, health and
development indicators.
In Indian population -
elite
Rich
Climbers
Poor
Destitute
65 million
185 million
250 million
150 million
200 million
6
In the morning session of 11 Aug. 2006, that What and Why we are doing? It
came out in the discussion that what ever we are doing it has certain values.
We brought up and bom in the community today what ever we are, it is
because everybody is giving his direct or indirect contribution; what ever we
get comes from the community. So it is the prime responsibility of every
human being to do some constructive work for the community.
In case of the community building community workers should have
some skills, such as :
1) Analytical skills
2) Listening skills,
3) Communication skills
4) Facilitating, discussion skills
5) Self learning skills
6) Organizing and management skills
7) Work implementation skills
In the end of the report of this first week following session were very
important.
1) Chikanahalli (Game)
2) Ralegan sidhi (case study)
These two taught us about the SPEC determinants , and improved our
thinking, about community building, and working in the community
with their priorities.
It change the perspective of community workers , it help to make a
positive attitude towered the community, and to make ensure their
participation to solve their problem according to their priorities.
The five stories of Ralegan sidhi have different perspective of the
community it told us about SPEC determinants, women empowerment
and some power relationship in the community. Some time when we
try to facilitate (training) some of the community member, it could just
like giving them some power; at this stage they can use their power for
their personal benefits, so that the decentralization of the power is
necessary, beside one person many persons in the community should
be trained, and their monitoring should must the responsibility of
community after. These ensure the community participation, and help
to utilize decentralized power, in the context of community health and
public health.
7
Report for the second week
- (from 14 to 19 Aug. 2006.)
Contents
1
Orientation
1.1
Globalisation
1.2 Social Exclusion
1.3 Rights, Movements and Campaign
1.4 Communicable Diseases
1.5 Non communicable Diseases
1.6 Peoples Health Movemetn
2
Field Visits
1.1
1.2
1.3
Milana
Mahila Samakhya
Life skills Orientation
Orientation
1.1
Globalization : -With the start of the week, we went through the
broader concept of globalization especially corporate led which is
increasing the poverty, malnutrition, environmental degradation,
pollution, health crisis, and leading to unemployment globally. The
wealth of the world population is going in the hand of corporate
minorities in the name of so-called development. Community and
Public is continue being violated, more and more hospitals are being
opened, with expensive medicines and diagnostics systems, high
frequency of checkups are putting unnecessary burden on the pocket of
a person. Whereas WHO recommended only 270 medicines for saving
life. But there are more then 80’000 brands in the market. In the name
of Globalization the rich countries of Europe, N. America and Japan
and the international financial institutions (IFis) like world Bank and
International Monitory Fund (IMF) demand that govt, should cut the
expenditure on health care, education, and even food subsidies, along
with them Indian multinationals are fielding in India, and
demographically being strong,
8
like
Reliance
Sahara
Tata
Infosys
Wipro
Bombay , U.P.
Buy real state, and finance in various
state capitals of India.
Orisa, Bhilai
Banglore
Hyderabad etc.
1.2 Social exclusion several social groups excluded based on cast class,
gender, lesbian, gay, Homosexual. They have their own health problems but
feared by disclosed identification, keeping them on lagging behind health.
Busy social life due to both working partners in the nuclear families in urban
areas, have bad effect on mental health of the child.
These challenges can be over come by only community building, and through
community building various activities can be carrying out to get the solution
of health problems. It must be clear in mind that we are not against the
development, but it must not be on the cost of poor people, we can’t think tof
development with any part of the community. Only together we can realize
development.
1.3.1
Rights it is defined as certain ideologies and as a institutional
mechanism provided by the govt, to protect the freedom of a human being.
Like - human rights, right to health, right to freedom, right to life . Etc.
1.3.2
Movements - it is a voice against, and a process of collective
work for the rights, it is against injustice, inequality, and could question and
protest against whatever is not being good, legal and against the freedom of
the community. It not funded, based on local resources, legal, and has a
certain ideology. Like Peoples Health Movement, NBA (Narmada Bachao
Andolan) etc.
Movement has two methods.
1
2
Direct Dhama, strikes, Media. Etc.
Indirect - Press conferences, distribution of leaflets, opinion
generation, research and survey
9
1.3.3 Campaign - it mobilizes to people or community on any certain
issue through networking and common interests, it might be funded, or
based on local resources. It try to get the attention of the state on behalf
of community on certain issues.
Like child rights campaign, reservation issue, etc.
When we talk about health we always think about the treatment of
diseases through medicines by doctors. Now what is the present
scenario of medicines in the market most of the medicines that are
being sold are unnecessary, Before 1975 in India only few medicines
were manufactured. But only in 1977 1980 flood of medicine
companies became appear. And continue it is growing, as a result of it
more then 80,000 branded medicines are in the market.
In the first five years plane India was spending 5.00 % on the health
but then 1.8% of total GDP and continue decreasing to 0.9 %. Even
primary health centers are not working properly and very essential
drugs are not available there. Privatization of public sectors and patent
in the health is increasing the cost of very essential medicines. The cost
of AIDS (ART) medicine in India is Rs. 8000/- per month, but the
same medicine in America is more then $100000/- per year.
1.4
Tuberculosis
It is the king of diseases and a big and serious matter of public health.
During the industrialization of the Europe especially in England
peoples became migrate towered cities to work in the industries. They
worked there at very low wages in unhygienic living conditions, lack
of sanitation, unventilated houses, had made worse to the life of the
labor class. Concerning these condition 25 % of the people died when
TB Begun to go an epidemic, and those man made conditions were
responsible for this epidemic
In India 5-7 lakh people are dying due to TB in every year. In the
presence of various state and national level TB programme. The
prevalence of TB is high in young man/ women.the national TB
programme (NTP)was introduced in 1962. Because if touch of support
to strengthen of primary health care services, the programme
implementation hhas no then good. DOTS is the short term six month
course for TB treatment, it stand for Directly Observed, Treatment
Short Course.
10
Various programmes have been carried out at national level by the
govt, of India. But RNTCP (Revised National TB control Programme)
is a revised programme of govt.of India for the Tuberculosis.
Diseases are closely linked with the social conditions and to reduce the
suffering level is a prime responsibility is the public health system, or
with community health workers. The case of AIDS it is going to be an
epidemic, and gender is looking a major factor in the prevalence of
HIV/AIDS. Women cant negotiate for sex form Husband,Hiv positive
person almost neglect by the community assume as a bad character and
always abuse by the community, and in the case of women it is worsen.
If HIV person died nobody comes to claim his body. Most of the
NGOs working in the field of HIV/AIDS are treating only with the
biological aspect or only creating awareness but the challenging work
is rehabilitation of HIV/AIDS positive person in the community. Public
health, NGOs, community health workers, should be responsible for
this and on the other side govt.
1.5 Non-communicable diseases:In the case of non-communicable disease, heart disease, high blood
pressure, cancer, diabetes our so-called development playing a major
role in the prevalence of these diseases. Poverty is in the root of all
diseases, because due to it they cant fulfills their basic needs like food,
water and sanitation, they are help less to live in unhealthy
environment and all these together effect to health. So that Health is
not related only with the medicines, but, poverty, Gender,
communalism, Migration, unemployment, health policies of the State,
National, and International are increasing severity of the diseases.
Environment around getting polluted, basic safe and clean drinking
water, inequality in the primary health care services, Contaminated
food, are the issue of public health, and continue being neglected or
hitting by inadequate attention of the State.
Migration is the cause of bad and ill health, western unhealthy, busy
life style, inappropriate practices of food habits or lack of nutrition in
food system are the issue of community health, and on behalf of public
health, Lack of proper planning, and strategy making, do strengthen to
the causes of diseases. Like malaria diarrhea, diabetes, and other noncommunicable diseases and disability. Due to development of unsafe
industrial practices, and mechanization, is the cause of physical
impairment, in the urban and use of machines in agriculture in the rural
areas.
11
1.6
PEOPLES HEALTH MOVEMENT
As it mentioned before that movement
is based on certain issues and
followed by its certain own ideologies, it is same with the Peoples Health
Movement. It is a result of long struggle of various organization after AlmaAta in 1978, in Which “Health For All by 2000 A.D. ” declared.
It is just looks like a second freedom in India as freedom from poverty,
diseases hunger unemployment bad living condition, side effects of privatized
healthcare which is not affordable by the people, in the long term struggle of
various peoples organization various programmes carried out by the Peoples
Heath Movement and end result of these programmes was the first Peoples
Health Assembly held in Kolkatta form 31st November to 1st December.
Perhaps it was the first peoples health Assembly like its own. In which
thousands of peoples got participate and put their problems, experience
before the nation. Popularity can be seen that govt, runs the special peoples
health trains for this assembly called Peoples Health Trains.
To conduct this assembly various programmes conducted during the year by
hundreds of national, state regional and local level NGOs, are as follows
- Block level Seminar
- Kala Jathas
- Policy dialogs
- Public hearings
- State level Assemblies
- People’s health trainings etc.
Objectives :
Hear to unheard
To reinforced the principals of heath as a broad cross cutting issues.
To develop coopration between concerned Actors or health workers in
the field.
To formulate peoples health charters
In the kolkatta assembly 200 issues, 100 workshops, by different 25
groups in just three days carried out.
PHM gave a new sprite all over the world to the organizations who are
working or dedicated towered Peoples Health. It gave strength to
slogan health is a human right and we from all over the world are
committed to achieve it. PHM changed the biomedical perspective of
12
health into social and said that not only Doctors, Medicines and loose
Health Care system, but Social, Economical, Political, Environmental,
Cultural War, and Violence conflicts and natural disasters also
effecting to the Health of the people.
It Demand
To the community to participate in decision making planning
implementation and the monitoring of community health and public
health and primary health care services.
To the Govt. — to make the policies and programmes according to need
of the community and try to make sure the community participation to
strengthen the primary health care system with equity and appropriate
technology.
2
Field Visits :
2.1 Milana
Our field visit in Milana was a new experience for my
fellows and me. It was a first time when I was directly interacting with the
HIV positive women’s. It was a learning for me that women’s who are
suffering form a disease (HIV/AIDS) fighting against it and not only against
disease but also against the social stigma, customs, Traditions and issues like
gender, Equity, empowerment, etc. their initiative to work as a peer worker is
really a brave step and a example for others who are suffering from such
types of diseases.
Milana is working with more then 290 families for the Community Based
Rehabilitation of HIV/AIDS patients. This organization is working
As a social support group.
As a Self-Employment training center.
As a Medical care and nutrition center.
Milana is not working only for HIV/AIDS, for the community health it is
working as a social support group and conducting various activities for the
families of HIV positive peoples and children’s for the community based
rehabilitation. And in the context of public health they are enforcing to govt,
to provide ARV medicines for the HIV/AIDS patients, and provide them
nutrition. Some time these ARV medicines given by the hospitals became
ineffective and cause of various side effects and disabilities. Like low vision
and blindness.
13
2.2
MAHILA SAMAKHYA
It is a govt, supported organization working in the KARNATAKA state. At
state level it comes under the department of education; it is funded by the
govt, and other funding organizations. It has different programmes for the
women empowerment and development, are as follows;
Economic Development programme
Under this programme Sanghas has formed it include 80-90 women’s in each
and through these sanghas some small savings done, and try to strengthen the
sanghas, time to time these sanghas catalyzed by the organization to take up
issues concerned with their problems. It at least providing them some space
or platform to express them self and to rats some issues related to women
empowerment, gender, development, violence, women and child health etc.
Work Area: - Four districts of Karnataka ,
RAICHURE,BELGAM,
KOLAR, and GADAR
Core Issues:
-being addressed by the sanghas -Health, Economic
Development Programme (EDP), Sanghas sustainability,
Panchayatiraj Participation,
Justice,
Legal
Literacy, Panchayatiraj
Reservation etc.
Nari Adalat this is a new programme of its kind, this NARI ADALAT
conducts on block and district level. The case of NARI ADALAT become
done with the consent and discussion of relatives, neighbors and villagers and
local leaders of the concerned person
OTHER FEATURES
MAHILA SAMAKHYA is running Kasturba
Gandhi Kanya Balika Vidhyalay. 5000 kishories (girls) has beeen
participated in the various activities of Mahila Samakhya.
14
Life skills orientation
2.3
Life skill is a skill to adaptive and positive behaviour , that enables
individuals to deal with effectively with the demand and challenges of every
day life.
Life skills use as a teaching method in which by the use of the skills various
work can be or carried out together and done successfully.
It involves 1
2
3
4
5
6
7
8
9
10
Decision Making
Problem Solving
Critical Thinking
Creative thinking
And Effective communication
Problem solving skills
Self awareness
Empathy.
Coping with emotions
Coping with stress.etc
By the various of life skills like roll play, listening, creative Writing etc.
programme can be made according to need.
1
Learning’s
world is progressing continuously, many
technologies are being introduced in the continuously and
globalization is the mean to spread them. As both side of the coin
globalization has the same quality, now its up to us that how we can
utilize it maximum for the community building and for health
development, as a appropriate techonology.
15
from 22 to 26 AUG. 2006.
Orientation
1
1.1
1.2
1.3
1.4
2
Tobacco
Social understandings equations and Health
CHW
Role of the community health
Field Visits
2.1
Foundation for Revitalization of local Health Traditions
(FRLHT)
2.2
Padmasini Asuri
Orientation:-
1.1 Tobacco: -Many of the diseases are the cause of the social problems, and
same the social, political, environmental, economical, and cultural, problems,
produce or cause many diseases. Tobacco is one of them, it could be said that
due to fashion in teenagers and younger, in most of urban areas, and culture,
and unemployment, in rural areas tobacco habits or practices are increasing.
When we say word tobacco, various ideas comes in mind like- injurious for
health, it kills, addictive and expensive, it bad for environment, big challenge
for health, it has big industrial production, cause of Ovarious disease, etc.
Tobacco session was figure oriented the policies of tobacco companies are
shocking that their targets groups are 13 - 19 year children, as a life long
user. In the context of SPEC determinants, politically strong intervention
should be toward stopping the prevalence of tobacco use and its various kind.
Life skills orientation can be used to prevent tobacco, and community
building, advertisement of using must be band and required initiative must be
take place. A strong intervention of NGO’s towered community building by
concentrating on individual counseling is desired one.
I would like to say that development is the cause of tobacco problem. It
introduced in India by the Portuguese during 19th century. It was the period
16
of industrial revolution (development) in Europe. I am putting here some
facts regarding tobacco. More then 25 diseases are directly linked with
tobacco.
Andhra pradesh and Karnataka are the highest tobacco producer states.
70000 million worth of paper used to wrap cigarettes 40 lakh children blow
15 years are using tobacco. 60% of people start smoking by below 13 year,
90% below 20 year.
1.2 Social understandings inequalities and Health :- In the process of
social exclusion and castism, it emerges in the community; and community is
nothing a group or groups of people, who lives together on a place or certain
area, exchange their thoughts, culture, costumes, traditions, respect and
maintain the relation. It accumulates various persons related to various caste,
ideologies, and many other things.
So that community is like a body, it has certain systems, it functioning
independent and it is the organization of various parts. In a community
various castes who think that they are better or ruler, started a system to be a
ruler or dominant always to suppress or under pressure of all the other
societies. World wide on some places it was based on color and language, but
some places like India it was and still based on religion. This system is called
varn veywastha (system), which contain four layers, first- Brahman- as a
priestly caste, Kshatriya - for security, Vaishya - Business and other work,
Shudra - worked as a servant class.
Beside all of them another people who identified later as tribe and dalits were
called as untouchable person. In the ancient period this system was very
strong and deep rooted in the society. The condition of People like Shudra &
Untouchable was worse, no body gave them respect, people like, Brahman
Kshtriya, vaishya abuse them and keep them away from their higher
society. Touching to these persons was sin. Continuous struggle against these
systems took a long time to eradicate from the society, but its effects still can
be seen.
The condition of the BHANGI cast peoples in Ahemdabad (Gujrat). This
society in the main urban area of Ahemdabad, and in other parts if India, is
still not looking respectful eyes. They are facing many problems because of
their work like gutter and drainage cleaner, road sweeper as a municipal
corporation’s worker. They are facing social exclusion, they are not getting
safe drinking water, lack of proper sanitation, and the power has cut down by
17
some people living in the Next colony. Nobody talk to them, upper cast
persons cant sit with them, their children facing discrimination in schools,
and neglected by the teachers and other colleagues. A municipal employee
got dismissed from his job, by asking about their rights.
On the other hand if we look at the society, we found power structure , where
some so called educated, political, and corporate societies who has the power
want to be dominant and to keep suppress to all other societies, and don’t
want them to be part of political or power structure. Politically on the name of
empowerment, they makes some policies, programmes it may be gives them
some economic profit but it is not realized the mean of empowerment. These
policies and programmes use as a mean of temptation. In this sense poverty is
a myth and a sort of socio - economic , political, and ideological exploitation
on man.
1.3 CHW :-The concept of CHV is carried out by Bhore Committee in
1946 before the Independence, after this in every panchayat of village health
committees formed and late 1960 and early 1970 a lot of voluntary
organizations started to work towered training and promotion of health and
health workers.
Rural health scheme in 1977 gave the philosophy —
“The community health worker will be from the community and will be
accountable to the community and community will be supervise his
work”
With community health workers we cant imagine and work toward
community health. They are the asset of the village, so the selection should be
in the hand of the local community, like panchayat, local habitant or villagers.
To utilize the services of the community health workers community should
know the health status of the village, and how it is effecting to the health of
local community. CHW’s should not treat only with the biomedical aspect but
must be work with SPEC or determinants of health.
CHW’s should work like
Activities providers, awareness creator,
Motivate - demanding for the services
Service provider - what ever are the primary health care services
should be provide with responsibility by the CHW’s.
Help in the govt, programmes.
18
As a comprehensive health worker .
1.4 Role of the community health worker
In the present scenario
community health worker is and will play a key roll in the providing primary
health care for the community health. I think the responsibilities of the
CHW s as a social worker should be decided by the community, according to
their needs, and the major role of CHW’s could be to help the community to
set their priorities as per their need. Like Education with job security,
awareness about health, their health problems, drinking water, and sanitation.
Here I would like to mention of the Chinese poem“Go to people, live with them,
-AyLy« y,
•
Love to them, save them
>
•
•
■
~
'1
>
,
".
'.’i
■
’■
«
This poem is guides us and gives ius the basic directions to work with in the
community. We should always learn from them, community workers should
change the paradigms by teaching of participatory learning.
In a community based approaches we have to facilitate them help them, and
have to find out the ways of community building. As a social worker it is a
opportunity for us that how we can make them aware, and get them together,
to help to realize and find out the problem and to motivate them towered
solution, and demand for need. This a kind of empowerment of community as
a whole, but it should be in mind that social, political, cultural, economical
discrimination should not take place.
Community workers should facilitate to the community to set out their
priorities, help them on decision making, action, demanding from govt, for
public health, and after the implementation monitoring must be by the
community. To work in the community CHW need following skills;
1
2
3
4
5
6
7
Analytical skills
Facilitation and discussion skills
Communication skills
Negotiation / conflict resolution
Self learning
Listening
Organizing / management skills. Etc.
19
2
Field Visits
2.1
FRLHT - Foundation for Revitalization of Local Health Traditions.
FRLHT is working as
A traditional medicine department.
To strengthening traditional medicine system like family tradition of healing,
local healers, bon setters etc.
Education of AYUSH system. ( Ayurvedas, Yoga, Unani, siddhas,
homeopathy.)
Make balance between modem science traditional science.
Conservation of traditional medicinal plants in forest areas.
In India 7 lakh are licensed medical practitioners and continue growing. Our
medical colleges are producing thousands of doctors, but tragedy is no one is
agree to work for out reach on remote villages.
In this scenario FRLHT started work towered the identification and
strengthening of local healers and local health traditions by giving them some
training, for primary health care. They use food recipes, hears, primary home
remedies, bone setters, education of jadi booti, siddha, yoga, are other allied
systems use to trained local healers.
To promote Local health Tradition FRLHT award to right local healers
Conservation and training about medicinal plants.
Amruth home garden - a practical way to meet primary health care .
A package of 7 to 21 medicinal plants species grown ‘in home premises.
Quality of this garden is, the garden plants use for the medicine, identified in
the surround area where garden has to establish. This reduces the chances of
biodiversity, and help to the peoples to know about the plants are found
around them (us).
Medicinal plant used for care of home remedies to meet primary health care
with local importance.
2.2 Mrs. Padmasini Asuri - We had a session with Mrs. Pdamasini Asuri a
nutritiense . She told us about our food and nutrition, our ancient food system
was very rich. It cooked according to the need of the body. Every human
being needs energy to perform the daily activities and we get it from our food
with the presence on protein and vitamin. A balance of various nutrients
required by the body for the growth or development. Nutrition is the
20
fundamental of health and with out health can’t sustain. For a healthy diet it is
not required to eat artificial or fast food fruits and others heavy diets but some
concentration of our daily diets give us the nutrition.
In the Bhagwat Geeta food has classified in to three form -
1 - Sativik food - Balanced food
-according to the requirement of the
body.
2 - Tamas
- high formatted highly salt
3- Rjas
- highly spicy
temporary energy.
She told about various types of food, balanced diet, energy food, need of
body, etc. and we also have a very testy and nutritious lunch with balance
diet.
Absence of hard work in human life is a cause of diseases and specially now
a days by the development of various means of traveling man has dependent,
busy and fast running life is pushing to human being in the sink of diseases,
but the most harmful thing is that we are getting the solution of our problems
(diseases) only in the biomedical model. But not looking toward our social
and cultural model or system, which gives us the complete solution of every
problem.
21
Fifth week :
1
Orientation
1
2
3
4
2
Health Structure
National Rural Health Mission (NRHM)
Transaction Analysis.
Confronting commercialization on Health.
Field Visits
1
1.1
4-8 September 2006.
L. C. Jain
Health Structure
Before the independence two committees were established for the health
survey.
1
2
Sakhey committee (1939)
Bhore committee
(1946)
It was the first time in India, when govt, took serious initiative to know the
health status, to find out the solution of the health problems. Bhore committee
gave the idea of health structure with the planning and framework.
In the ancient health system was very strong Ayurveda, siddha, yoga unani
healing methods used to solve the health problems, but after arrival of
britishers allopathic healing system introduced and became more and more
stronger by the time an d still continue. Now most of the amount spent for the
health structure goes to make stronger allopathic system. System doesn’t
good or bad, but it depends on its functioning and how it is beneficial to
community health.
India has three-tier health system at state, district and local level.
In the village, - sub centers, local health workers (CHW.ANM.AND MPW’s)
dale’s, anganwaries traditional healers, bonesetters, jadi- booti herbalists are
working.
At block level - primary health centers,
22
at district level - community health centers.
In the big cities big hospitals both govt, and private are ’working
' L for the
community health. Most of the private hospitals owned by corporates; are so
expensive some specialized hospitals are also
‘
for special diseases. But are
away from the reach of a local people.
Some old healing system are also running by the govt, but lack of proper
attention, staff and medicines they are taking an ending breath.
In India 25 national programmes are going on and all are based on the
allopathic treatment, mean bio medical models are being adopt by the govt, in
the every programme.
II
ISSION(NRHM)
It is the programme of govt, of India at the national level. Govt, first time
spending its proper attention towered AYUSH system, this is the first
programme, which is conducting by the direct intervention of the Prime
ministers office. But the lacuna is that govt, is not increasing the budget of
health according to the population increased.
In India per capita health expenditure by the government is
Rs. 80-120/per person/ per year
Rural share is Rs. 30/per person /per year
But the nation wide it should be $ 40/per person / per year
In NRHM at state level Integrated State Health Society formed and all
vertical health programme made integrated under this society at district and
state level. Three top-level secretaries; are involved to execute this
programme.
Main features of NRHM are
- Decentralization
- Link with AYUSH system
- Civil societies participation
- Priorities focus on 18 states, which have bad health indicators.
- Focus on health determinants by many programmes.
- Interdependent linkages with panchayati raj institutions, ICDS, family
welfare dep. Women and child welfare schemes. Etc.
- Increasing number of CHC’s according to the Indian public health
standard system. (IPHS)
23
Provision of ASHA workers, to ensure the adolescents, women and
child health.
1.3
Transactional analysis
Human being has three types of psychologies or behaviors
1) Parent
2) Adult
3) Child
Parent psychology is always creates conflicts, if two person will behave like
parents can’t be agree on one thing.
Adult psychology has learning system or behavior. With this two-person
listen to each other, respect to each other, and try to be agree on one thing,
and get positive result.
Child psychology keeps person always in a learning or taking position; when
a person want to get teach by some one or want to get solution of their
problem.
1.4
Confronting commercialization on health
In present so called development age, we have the biomedical concept of the
health, and it is promoted by the private doctors involved in the clinical
treatment, so expensive and harmful for health and wealth of a common
person by private hospitals having expansive diagnosis and unnecessary tests
or specially by the drug companies both national and international marketing
there are more then 80,000 brands in the market. Where as most essential life
saving drugs list by WHO are 270.
More then 80 % of drugs in the market are not useful. We should use generic
in place of branded. In one 75 % health care is private and only 25 % is govt,
and on the other hand govt, is spending very less per capita income on health.
Corporate sectors are involved in health care and health sectors are way of
investment and making money. They are overcome on the govt, sectors, more
and more govt, companies are being privatized or getting off.
Now the patent is emerging as an epidemic and spreading all over the world.
!
It is nothing but a marketing monopoly, by which maximum exploitation of
man is become possible. Ones a medicine got patent the owner will decide the
24
cost of it, no matter whether a man can purchase it or not for i.e. in USA,
ARV (drug use by HIV/AIDS patient) medicine is patent and cost is
2,50,000/per month, it is a product patent. Where as India its cost is 8000/per moth, it is a process. So that many of African countries are purchasing it
from India.
More then 6000 crores per year is spending by the MNC’s on drug
promotion. Irrational medical care is supporting and promoting to these drug
companies. Indian spent about 15000 crores every year, and 50% of the
money they gives for unnecessary diagnosis and treatments.
What to do
Demand to the strengthening public health systems.
Ban all the irrational drugs, and introduce the list of essential
medicines.
Patient education on the rational medical care, and demystifying
doctor’s patient relations.
- Public health policies should be according to the prioritized need of the
community, andn during the policy-making involvement of the civil
societies and NGO’s should be ensuring.
- Dialogue with professional bodies to catalyze strengthen and support
professions internal initiatives for the reforms.
-
2 Field Visit
2.1 Mr. L.C. Jain
This was a short visit was the part of our field visit orientation at different
places and Mr. L.C. Jain was a last person to whom we visited. We got a lot
of things or thoughts of history in the reflection of his good or bad experience
in the past. Some of the things about him or we gained from discussion with
him are as follows;
He is a physically not very strong but energetic, enthusiastic happier person;
identify peoples very easily and build very quick relations. He met us as a
friend and took introduction from all of us, like what we did and will be done,
and why we opt this field as a profession.
25
He told us about the challenges of the social work field have faced and facing
by Ibe socal activists, like Medha Patkar, Arundhati toy, and about Samay
by 0,herel“duri"8 ,he
”
He suggested us to read his following books :
1 - Dam and conflicts.
2 - Dam v/s Drinking Water.
Learning
Major learning during this period are as follows,
1
2
3
4
5
6
7
8
9
10
Health structure should be more and more decentralized.
More health workers should be trained at the village level and
selection process should be in the hand of the local community ’
Community has to play a very important role to the development of
All the programmes should be prioritized according to the need of
the community
Local health traditions can play a major role toward the
improvement of health of the community.
Privatization of health and health care system and involvement of
the corporate in this field is making the situation quit dangerous.
Relations among Doctor and patient should be demystified.
Patent is nothing but a form of earning money and exploit to the
community, for their own sake.
Product patent is much more harm full then process patent.
Involvement of civil societies and NGOs working toward the health
is important in policy making process.
26
CBR REPORT
• INTRODUCTION
• AN UNDERSTANDING OF COMMUNITY
BASED REHABILITATION
• INTRODUCTION OF /CBR FORUM.
• CBR EXPERIENCES IN THE FIELD:
PLANNING, MONITORING, CAPACITY
BUILDING, AND EVALUATION OF CBR
PROGRAMMES IN THE FIELD.
• ADVOCACY
. PERSONS WITH DISABILITY ACT 1995
. LEARNING’S AND SUGGESTIONS
' <
■
CHAPTER FOUR
Introduction
4.1
□
Placement at CBR Forum
This study is conducted as a part of block placement to fulfill the partial
requirement of Community Heath Fellowship scheme (CHFS) of the
Community Health Cell, Bangalore.
The overall objective of my block placement was to built my personal
capacity in the field of Disability and Community Based Rehabilitation.
My other general objectives were:
1
2
3
4
5
To learn about planning, monitoring, evaluation of a field level
CBR programme.
To gain an understanding about CBR Forum and it’s functioning.
To understand the manner in which the capacities of PWDs are
built up through a CBR programme.
To learn how advocacy is done through a CBR programme.
To carry out some research activities in relation to PWDs.
To achieve these overall and general objectives the study has been well
designed and planned including both the theoretical and practical approach,
which includes the study of both primary and secondary data and exposure
through field visits.
(see planned schedule annexure 1.1)
In the following chapters I have tried to give a clear picture of my CBR
experiences in the field: on planning, monitoring and evaluation of CBR
programmes; of the manner in which the capacities of PWDs have been built
through a CBR programme and of the way in which advocacy is promoted
through CBR. I have also reported on a study done by me on the UN
Convention of 8th Ad hock committee on the rights of persons with
disabilities and have suggested the manner in which the PWD Act 1995 needs
to be amended in keeping with the afore mentioned document. I have ended
by listing my learning’s in this process.
27
4.2 Community Based Rehabilitation Approach.
The end of this millennium and up to now we have seen some
sweeping changes both positive and negative in the world, including changes
in economic trends toward globalization the tremendous advancement in the
information technology, the increasing rate of world population, and so called
development. GDP growth of the countries, which Is definitely increasing the
standard of individuals life up to some extent on one hand, but on the other
hand income gapes between rich and poor in the world , especially in the
developing countries. Increasing rated of poorest people in the world and so
on. Health crisis, prevalence rate of diseases, natural disaster, conflicts and
war, are these things together are contributing greater in the problem of
common man. It becomes more dangerous when we talk about Persons with
Disability. These changes have influenced the life of Persons with Disability
(PWDs), and thinking of all those peoples who are working or involved in
disability issue in various ways. The rights and entitlement are continuously
being denied or violated at individual and community level. Community
health and Public health services are not providing very well as it should b.
In many developing countries “individual’s rights as expressed in
industrialized countries do not exist”. Traditionally in these countries
individuals is bom in a kinship group with a network of relationship that
involve the mutual obligation with regards to religious and economic factor.
People look towards their immediate kin for welfare and help, rather then at
the traditional western types of formal services. Because of this kind of
relationship, the process of empowerment of an individual in the society is
more complex, irrespective of whether he is a person with disability of
otherwise.
In the past two decades, WHO, ILO, DFID and UNDP, have made
greater efforts to promote a most cost effective home based rehabilitation
services delivery system , which is designed as a community therapy
programme called CBR in the developing countries. In the beginning this
model practiced located intervention, nearly identical to that of the clinical
setting in the institutions, dealing primarily with the impairment. Gradually it
was recognized that these programmes did not produced the desired impact
28
unless the extrinsic cultural factors were recognized and goals modified
accordingly. In 1944 the UN organization in their joint paper, reviewed CBR
in a different perspective and emphasized the contribution from the external
contextual factors. The goal of CBR programme was redefine as integration
of PWDs with in his community, rather then relief of impairment of disability
in the PWDs . This broader view of CBR in developmental perspective,
reduce the importance of medical rehabilitation in to a less significant
peripheral activities.
Determinants of Disability:
Poverty is the major determinant of disability.360 million people who
are living below poverty line are the most vulnerable for disability, and by
this they are suffering from malnutrition. Living in unsanitary and crowded
conditions, have no or limited access to medical care. Social phenomenon,
with different cultural and traditional believes, traffic accident, war and
conflicts, poor education, lack of confidence, lack of proper health care
system especially during pregnancy (could be due to poverty / customs /
traditions / lack of access of services), poor industrial practices, and chemical
and fluoride poisoning, and in the last finally age is the major determinant of
disability. It is contributing 36% of disabled population.
29
CHAPTER FOUR
4.2
4.2.1
An understanding of Community Based Rehabilitation
Community Based Rehabilitation
Generally people define “Disability” as physical or intellectual impairment,
which has long-term consequences. Because of this understanding, the
majority of disability-related programmes are aimed at maximizing disabled
people's physical and mental abilities - meaning that the main focus is on
medical/technical interventions.
Disability is a developmental / social issue rather than a medical / technical
one, because disability is just not a medical condition. The lives of disabled
people are made difficult not so much by their specific impairments, as by the
way society interprets and reacts to disability. Disability segregates / isolates
the person and often the family, in their own community. They are not
considered as a part of mainstream life. It is not generally recognized or
accepted that disabled people have equal rights as citizens of our country and
should have access to equal opportunities like the rest of us.
Can’t do this” and “Won't be able to do that” are phrases we all hear
frequently about people with disabilities. Such negative attitudes - their own,
as well as others’ - have resulted in pushing people with disabilities onto the
margins of society and have denied them their human rights.
People with disabilities have some problems, but they are certainly not devoid
of abilities. They are just like the rest of us. Like all of us, they have some
abilities and some disabilities. They are not strangers — they are members of
our families, our neighbors, our friends and colleagues.
(Notes of Mr Goutam Choudhri report on CBR)
30
We believe that all of us are entitled to all the same human rights, regardless
of the way we look or behave, regardless of our specific abilities and
disabilities.
The need is therefore for a process of social change that is sensitive to and
incorporates the needs, experiences and priorities of people with disabilities.
An approach not with a medical bias but with a social bias - a recognition that
society needs to adapt and create space for the requirements of disabled
people amongst others, so that they also become a part of mainstream life.
Such a process cannot come about if people with disabilities are excluded
from society - they must become a part of society, meet and relate with
others, work and struggle together, respect them selves and gain respect from
others.
The history of rehabilitation shows that it all began with parental concern for
the disabled child. The concern of the parents and the immediate family
members led to their involvement in rehabilitation of the affected child. Later,
institutions were set up by the state or by non-governmental organizations.
In our country, the sorts of services the people with disabilities (schools,
clinics, hospitals, etc.) receive are mostly city based. Institutional Based
Rehabilitation (IBR) has a general acceptance especially among able-bodied
persons because of institutional care for the disabled persons. It is based on a
high degree of professionalism and is expected to bring in quick and desirable
results. It is mostly confined to towns and cities, inaccessible and unsuitable
to people with disability in the rural area though about 80% of people with
disabilities in India are living in the rural areas. The rural poor are particularly
at risk of those disabilities, which are associated with malnutrition, poor
conditions of environmental sanitation and communicable diseases. Accidents
arising from negligence, ignorance and lack of safety measures at work and in
31
the community are also major causes of disabilities. Residential institution
develops negative attitudes among persons with disabilities as regards the
desire to return to their homes, this leads to segregation of peoples with
disability from the community. It is not affordable to the Governments in
developing countries that have limited resources.
Gradually it was felt that the coverage of persons with disability needs to be
increased and rehabilitation services should be universalized. Some of the
international agencies like WHO, ILO, UNICEF has promoted an alternative
approach.
The label of Community Based Rehabilitation (CBR) was one that has taken
up and promoted by the WHO. In 1981, WHO defined CBR as an approach,
which involves, utilizes and builds on existing resources in disabled persons
themselves, their families and communities”.
Several factors were being cited in favor of adopting such an approach. These
included:
* Lower costs
* Wider accessibility and coverage
* Community involvement leading to permanent change.
^l^lDefinition of CBR
The joint ILO, UNESCO, WHO statement on CBR defines CBR as “a
strategy within community development for the rehabilitation, equalization of
opportunities and social integration ofall people with disabilities. ”
According to the Einer Hilander ; “CBR is a strategy to improving the
services delivery, for providing more equitable opportunities and for
promoting and protecting the Human Rights of the disabled peoples ”,
32
UNO in 1976 defined CBR as “a serious effort towered deinstitutionalizing,
derpofessionizing, and demystifying services for the person with disability”.
The concept of CBR is multifaceted and each face can be looked as a separate
entity altogether. It can be understood from different dimensions and
perspectives in accordance with its activities.
Today the main goal of the rehabilitation has become broader then earlier,
and focus beyond the individual, to his community where he is being
integrated, thus the universal mission of the CBR may be expressed as:
To enhance activities in daily life of person with disabilities.
To create the awareness of persons with disabilities environment to achieve
barrier free situations
around him and help him attain equal human rights.
To create the situation in which the communities of persons with disabilities
participate
fully and assimilate owner ship of their integration into his society.
From one dimension, CBR can be understood as a medical rehabilitation
approach, which concentrates on the community health, prevention of
disability and early medical intervention, which aims at physical development
aspect of PWDs and other in the society.
Among the weaker sections PWDs are people who are more vulnerable to
exploitation and injustice because of their disabilities. Many children and
women are subjected to harassment by others, or their own near and dear
ones, in many ways. CBR take into account the efforts of education and
imparting knowledge and skills for positive attitudinal change regarding the
PWDs, so that they live in a much safer, equitable, productive and barrier free
environment. CBR involves advocacy for the rights of PWDs and related
issues and it is therefore also considered as an educational approach to the
development of PWDs.
CBR is also imparted as a participatory approach to the development of
PWDs. In order to reach out to a number of peoples and attain and retain
sustainability, people’s involvement is needed. Moreover people’s
involvement in the CBR process ensures fairness and accountability in the
programmes. The long-term target of CBR is that people should be
empowered in order to make them able enough to handle their own
33
developmental affairs. CBR is achieving this goal by decentralizing the
responsibilities and the resources, both human and financial, to the
community or grass root level organizations, so that maximum number of
needs of PWDs and others are planned out and addressed bearing in mind the
decision of people. CBR breaks the donor beneficiary approach, which is a
top down relationship.
All these aspects or faces of CBR act as a catalyst to each other in
maintaining the momentum toward the overall and all round development of
PWDs. All these aspects contribute to the development of the PWDs along
with other non-disabled people in the society. All these come together and
ensure the holistic and all round development of the persons with disability in
every sense, like physical, psychosexual, intellectual, socio-cultural,
economical and spiritual.
We can conclude that CBR in its holistic and truest sense, in this present
context, can be understood as a community development strategy which takes
into account the development of its parts out of which one is PWDs.
Therefore, CBR involves more than rehabilitation efforts carried at the
community level. As a social policy, CBR promotes the right of people with
disability to live with their communities, to enjoy health and well being and
to participate in educational, social, cultural, religious, economic and political
activities. Through this process people with disability become empowered to
take control of their own lives and situation.
CBR is a combined effort of disabled people themselves, their families and
communities, and the appropriate health, education, vocational and social
services.
4.2.3 Why CBR?
The basic question that arises is why CBR and not rehabilitation clinics or
institutions?
Rehabilitation began with:
>
The concern of the parents and the immediate family members and
>
Institutions set up by the state or by non-governmental organizations:
■J catering to a small number of persons with disability;
>/ offering costly services;
34
'J largely based in urban areas and cities which are not accessible to
the common man in rural areas;
requiring professionals whose training is time consuming and
retaining them is not easily affordable.
If the coverage of persons with disabilities needs to be increased and
rehabilitation services universalized, they have to be community based.
Notes of Mr Goutam Choudhri
Community Based Rehabilitation (CBR) brings rehabilitation know-how to
villages and urban slums in India, and CBR personnel teach or help people to
take responsibility for their own lives!
The process of CBR as the name implies, has to have its roots in the
community and has to derive sustenance and support from the community.
■
4.2.4 Basic Principal of CBR Programme
Enabling services at the home setting of the Persons With Disabilities.
Capacity building of the local human resources, especially PWDs to
provided the services.
2
Delivery of the optimum quality of the services, which will build on
the traditional good practices of rehabilitation.
3
Ensure the community who benefits from the services gradually
takes over the responsibilities of managing the rehabilitation
programme.
4
Ensure participation and involvement of the persons with
disabilities in the Planning, Monitoring, and managing the
programme.
5
CBR workers must be flexible so that they can operate at the local
level and with in the context of the local conditions.
6
Local resource should be tapped to the maximum.
7
Ensure that the rights of persons with disabilities are not denied.
1
1 .Annual report of the CBR Forum 2005 -2006
35
4.2.5 Essential components of a CBR Programme
Community Based rehabilitation of persons with disabilities should be part of
the entire community programme for the integration and inclusion of all the
persons with disabilities, beside this the community participation in every
programme, ensure the success of the programme. It must be in mind that the
entire scheme and programme are according to the need of PWDs, and
following essential component should be included in the schemes.
1.
Creating a positive attitude towards people with disabilities.
2.
Provision of functional rehabilitation services.
3.
Provision of education and training opportunities.
4.
Creation of micro and macro income generation opportunities.
5.
Provision of care facilities.
6.
Prevention of the causes of disabilities.
7.
Management, monitoring and evaluation
4.2.6 Major players in the implementation of a CBR Programme
When we talk about the major players and their role in CBR programme,
community always will be on the priority, without it the concept of CBR
can’t be imagine. Some of the major player at the community level are as
follows.
1. People with disabilities
2. Families of people with disabilities
3. Communities
4. Governments (local, regional, national)
5. Non-governmental organizations, local, regional, national
6. Professionals.
42.7 Challenges in CBR
___
The process of the CBR is not quit easy to implement it in the community, a
lot of challenges are lying before the NGOs and community health workers or
CBR workers in the effective implementation of CBR programme, various
determinants like, socio cultural, economical, political, and attitudinal factors
36
work together as challenges,
Challenges.
beside these following also consider major
Care of severely and profoundly disabled in the homes and by the
community.
Sustainability of CBR programmes by the community - to what extent
is it possible? What are the prerequisites for ensuring sustainability?
Rehabilitation of the disabled through CBR in very remote, poor and
backward villages where resources for rehabilitation are nearly absent.
Attitudes and Acceptance
Community Priorities
Trained manpower
Lack of research, appropriate technology and advancement of
rehabilitation science
High and unrealistic expectation from the community
Group dynamics, community dynamics and community composition
Non-acceptance of rehabilitation services and measures
Indifferent attitude of the Government, NGOs and other key players in
rehabilitation
Creating a barrier free environment for all persons with disability
Implementation of the Persons with Disability Act of 1995.
There is a well-known saying that “ if you give a person a fish, he’ll eat for a
day; if you teach him to fish, and he’ll eat for a lifetime”. Community Based
Rehabilitation (CBR) brings rehabilitation known-how to villages and urban
slums in India, and CBR personnel teach people to take responsibility for
their own lives.
We believe that if we all work together, in a spirit of loving and caring,
people with disabilities can overcome their difficulties and get back their
sense of self-confidence, competence and independence.
People with disabilities have the capacities and potential to manage their lives
on their own. With this faith, people like us can also help them in their
struggle for gaining their rights - which is our common struggle for a just
society.
|
4.2.8 Requirements to start . CBR progr»n,me
If an organization wants to start a CBR programme, they can consider the
following points:
37
• Find out whether the disability situation in the area justifies the
commencement of a CBR programme: is there a need to work with the
aim of facilitating social inclusion of people with disability?
• Do a general analysis of the community including resources available in
the area.
• Help the people with disability to articulate their need.
• Help them to get a response from within the community.
• Plan to involve children, their families and the community in all the
activities from the very beginning and at every stage, to build a genuine
partnership rather than a relationship of dependency.
• If needed ensure the availability of support of professionals from outside
the community.
• Use local resources available in the community to provide necessary
services. As far as possible, utilize existing services and facilities.
• Gradually transfer the skills of rehabilitation to the parents of children
with disability, adult PWDs and also to the first contact people such as
anganwadi workers and village health workers.
• Disseminate information on disability and the rights of persons with
disabilities.
• Create a positive attitudinal change about the abilities of persons with
disabilities.
On the whole they should try their best to help people with disabilities and
their families acquire the confidence to make necessary decisions for their
future and help them to become confident, self-reliant persons, respected and
active members of the society.
38
CHAPTER THREE
4.3 An understanding of Community Based Rehabilitation
Forum (CBRF)
4.3.1
Genesis of CBR Forum
For many years, Misereor Germany has been assisting the projects involved in the
rehabilitation of person with disabilities. In the last few years there has been a
steady and steep increase in the number of such projects and the quantum of
financial assistance as to merit their special attention. After articulating the need
of clarity in decision-making, Misereor decided on a focused policy, relating to
disability rehabilitation projects in India.
in formulating the policy of disability rehabilitation in India, Misereor take into
account three main fectors, namely magnitude of the problems of disability in
India and consequent need for the wider coverage, the need to have a specialized
"think - tank", and conscious decision making within the country .
Misereor then prepared a approach paper" toward defining the Misereor role with
regards to support of people with disability in India" in early 1994, which was
circulated to people involved in the field of disability rehabilitation in India.
Subsequently a work shop was held in Madanapalle Andhra Pradesh India march
1994 with about 35 invited participants from all over the country discuss the
modify and approach paper and to develop some guidelines for the taking the
process forward.
The workshop of Madanapalle resulted in three clear out comes regarding the
future policy of Misoreor in the field of disability rehabilitation in India.
The first was that the community Based Rehabilitation (CBR) approach would be
given priority for support.
Secondly, it was agreed that the advocacy and awareness raising were important
issue and need to be supported.
Finally, the workshop recommended that a Forum should be set up in India as an
independent entity to play a proactive and pro-active role to implement the
policies.
The CBR Forum was subsequently formed in 1996. It has three institutional
members; Misereor based in Germany, Caritas India and CBCI both based in
Delhi. The Forum can have a maximum of nine others members. Presently CBR
forum is located in St. Thomas Town Post, Bangalore, and Karnataka.
(Mr C. Oddessy singh" block placement report) (Report by Misoreor on CBR)
39
[4.3.2Vision of CBR forum:
"The vision of CBR forum is that people with disabilities have eaual
opportunities leading to improve quality of life and fully participate fo a
society that respects their rights and dignity".
4.3.3
Mission of CBR forum: -
The mission of CBR forum is to play a proactive and promotional role in
community based rehabilitation of person with disabilities in India, ensuring
wide coverage with focus on the disadvantaged groups such as the poor
women, and people living in the rural areas and urban slums."
4.3.4
Objectives of CBR forum: -
4.3.4.1
General objectives: CBR forum Promotes, supports and
empowers organizations and people and movements for CBR by creating Equal
opportunity for social integration of PWD's specially among the disadvantaged.
4.3.4.2
Specific objectives:
1)
Create awareness and sensitivity for attitudinal and behavioral changes
among PWD s and the general about issue in disability, prevention and
management.
2)
Enable and enhance the capacities of PWD’s, their families, communities
and organizations for the development of sustainable approach for
integration.
3)
Network with organizations and govt, at all levels for influencing policy,
action, and legislation, for integration.
4)
Promote and support of peoples with disabilities.
5)
Develop and promote a body of knowledge and skills in the area of CBR.
Mobilize resources for CBR activities.
6)
Annual report of CBR Forum 2005-2006
40
9K& Organizational Structure of CBR Forum
12 Member in all:
03 institutional Members
01convenor
08 Others
Project Selection
Excutive committee
Convenor
Secretaria
Director
Programme Coordinator
Training
Programme Coordinator
Advocacy
Programme Coordinator
4.3.6
CBR Forum as a developmental Organisation
Today, CBR Forum plays a vital roll in implementation and spreading CBR
programmes in every nook and corner of India forming a strong networking
system with many partner organizations who are working at grass root level in
rural areas and urban slums, especially the downtrodden section of the society.
Acting as a catalyst to these organizations in the implementation of the CBR
programme, CBR Forum also acts as the monitory backbone of these partners'
organizations. They assist these partners not only with requires finance but also
with relevant inputs to take forward CBR programme. So from an angle the Forum
can be considered as a funding agency though the funding activity is of secondary
priority to the forum. It is also to be noted that the forum does not implement the
programme directly but only through its partner organizations. The main source of
funding of CBR Forum is the MISEREOR, Germany.
Every year the secretariat prepares the project proposal to send to Misereor
Germany for the funding this proposal before sending to Misereor goes to CBR
Forum board where it is through discussed / assessed.
After this, the proposal returns to the secretariat with or without suggestion,
modification/ alteration. Then the proposal is forwarded to Misereor by the
secretariat.
Misereor Germany assesses the proposal. If they find it all right they straight away
send the MOU and a copy about it is sent to the secretariat, with the agreement,
fund is released to Caritas India, which is the legal fund holder. At the same time,
a copy of the details of this transaction goes to the secretariat. In case, they have
some alteration to be made in the proposal, then they send it back to the
secretariat with desired suggestions/conditions for the alterations.
After assessing the /suggestions and conditions the secretariat present it in front
of the board. Then the board studies the proposal and the suggestion/condition.
Then they take a necessary stand (with or with out the acceptance of the
42
suggestion/condition laid down by Misereor Germany) and the proposal is sent
back to the secretariat. If they are not satisfied, they can again send to the
secretariat. And the same procedure repeats.
4.3.7
Functioning of the CBR Forum
4.3.7.1
Regarding to the partners organizations
The secretariat assesses the proposal, if it is not with in the norms of the forum it
foes not study the proposal further. On the other hand if the proposal with in the
norms, the secretariat appoints a resource person for the assessment of the
organization, with the field reality and its needs. The resource person is also
requested to present specific suggestion and clarifications or make the project
more realistic and need based. After the assessment, the resource person can
either recommended and support of the proposal with or without suggestions or
reject it.
If the secretariat finds the support with out any suggestion from the resource
person, then the project or proposal goes to the project selection committee.
In the case where the support is with suggestions, the secretariat informs the
organization of the suggested conditions, if there are any from the resource
person. The organization either can agree to include these suggestions or can opt
to withdraw its proposal. The secretariat is informed accordingly. If they agree
then the secretariat, forward the proposal to the project selection committee.
The project selection committee studied the consolidated reports presented, by
the secretariat and submits their decision for support / rejection to the board of
the Forum. If the proposal is supported then it goes back to the secretariat. The
secretariat finalizes the proposal of those whose proposal have been accepted and
forward the same to Caritas India, Delhi for the release of fund and at the same
time, this approval is informed to the implementing agency or applicant.
Caritas India sends the memorandum of understanding with its term and
conditions to the applying organizations ending a copy to the secretariat at the
same time. Even at this stage, the organization is free to back out by refusing to
43
sign the MOU. If it does sign the MOU, it becomes a partner of Caritas India and
gets funding from the forum through Caritas India for their CBR project. Every
time the Caritas India releases the fund, a copy of details of the fund released is
sent to the secretariat.
The secretariat also has the responsibility to inform the implementing agency
whose proposal has been turn down at any stage, of the inability of the forum to
work with them as a partner.
This is how the organizations, who apply for the CBR project, can become the
partner of the CBR Forum.
Just after the linking up, the new partner organizations have to undergo a
sensitization workshop, where the coordinators and CBR workers are given
training for 40 Days. The coordinators have training for another 12 days in
addition for the 40 days training. Directors and applicants of new partner
organizations also have training for 2 days.
The forum look at the possibility of partnership of maximum of 8 years and
another one year in a specific project area which spread over five phases;
Phase
’
Period
1
~9
Month
2
~2
Year
3
T
T
T
Year
4
5
Year
Year
Today, CBR Forum covers 18 states having 88 partners organizations in India
which are located in the following broadly categorized regions namely,
Southern Region
Karnataka Region
11 organizations
Kerala Region
14 organizations
44
Andhara Pradesh Region
12 organizations
Tamilnadu Region
10 organizations
(for the list of partners organisations refers Annexure 3.7.1)
Northern and Western Region
Madhya Pradesh
1 organization
Maharashtra
03 organizations
Delhi
02 organizations
Rajasthan
01 organization
Utter Pradesh
03 organizations
Jammu Kashmire
01 organization
Northern Eastern Region
Manipur
05 organisations
Assam
02 organizations
Meghalaya
01 organization
Eastern Region
West Bangal
04 organisations
Orrisa
06 organizations
Jharkhand
07 organization
Bihar
04 organisations
Out of these partners 04 organizations from Manipur, and 01 organisation from
Meghalaya are being funded by Light For World (LFW) Foundation, Australia, and rest are
being funded by the Misereor Germany.
45
P4.3.7.2
Training of partners
Partners are given systematic inputs on various occasions.
a)
During project management Workshop, the focus of the inputs is on;
> Introduction of the concept of CBR and CBR Forum.
> Expectations of the Forum / Funding agency as regard to programme and
financial management.
The mode of drawing up a realistic rehabilitation plan for Each individual
PWD, keeping in the mind the need of PWD to plan intervention at the
individual and social level.
> Inputs on activities and financial planning.
>
b) During reflection workshop, the focus of the training inputs is on :
Ensuring that the provision have been built in to the plan to care for:
Prevention of disabilities
Networking with other partners and NGO's
Formation of Self-Help Groups, and their eventual Federation.
Identification of Human and Material resources in the project area.
Meeting the provisions of the disability Act.
c)
During the field level facilitation visits the focus of the training inputs is on :
The mode of drawing up of realistic rehabilitation plan for each individual
PWD, keeping in mind the need of plan for intervention at the individual and
social level.
Upgrading home management skills
Upgrading financial management skills.
Upgrading activity and financial reporting skills.
Facilitating and capacity building of the PWDs, their family and community
members in view of enabling them to take over the programme.
d)
During the regional level meeting of the partners, the focus of training
inputs is on :
Functioning of SHGs
Advocacy and lobbying
Mainstreaming of disabilities.
Feedback from partners on training imparted by training centers.
Working with Govt.
Millennium development goal.
Future role of CBR Forum in India.
Sharing the stories of rehabilitation through CBR; both success and failures.
Indicators of achievement for each phase of the programme.
46
e) In addition to the above through approved training centers of CBR forum,
all partners organizations receive training inputs from one of the training
centers of the Forum;
SANCHAR in Kolkata, West Bangal.
BLIND PEROSN ASSOCIATION (BRA) Barodara, Gujrat.
ADD India, in Bangalore.
The focus of the training inputs through a 40 days training programme and
sensitization workshop during phase one is on;
Imparting know - how to CBR workers and coordinators on CBR and skills
required to care for various types of disabilities.
Imparting additional skills to co-coordinators on management of a CBR
programme.
Know -how the directors /applicants on the demand of the CBR
programme.
In addition to this on going training programme of 7-10 days given every
year (from phase II onward) at field level to all the partners based on their
specific needs.
4,3,7,3
Advocacy
■
;l
Besides working with the partners organizations CBR Forum has its direct
intervention by his own staff in the field. The secretariat has started working with
the former assistant commissioner of disabilities of the Karnataka State Govt, to
sensitize officers of 10 district of Karnataka states on their role in insuring that the
provisions of disability Act met. This is done through taluka level disability
management programme. The forum works with the officials of the districts where
partners of CBR Forum are already present, the forum has successfully organized
a 1 day sensitization programme after which the commissioner has ask to the
district officer to report on quarterly basis to the commissioner office as regards
follow up action taken to take the provisions of the Act forward.
47
4.3.7.4
Networking With the Funding Agencies:
CBRF took the initiative to bring together funding agencies that funded
programme for the rehabilitation of PWDs ; Abilies, AIFO, CBM, ACTION AID, SLF,
and TDH (G). Basic need an organization that gives minimal funding and technical
support to partners in the field of the mentally ill was also present for these
deliberations. All those present opted to work together for the promotion of CBR
of PWDs. Good practices of CBR are reflected upon. Information of prospective
partners is also exchanged.
4.3.7.5
Monitoring of the projects:
Monitoring of the selected projects is done every six months. This is done in view
of making these model projects. The staff of CBR Forum secretariat visits to the
partner's organizations and monitor the CBR work. In this visit they analyze the
progress of the organization in the implementation of CBR through a detailed
examination of documentation maintained by the partners organizations. Through
field visits and through the interaction with the CBR workers, PWDs, their families
and the community, in this process checking of accounts is also done. Based on
the needs at field level, the team of CBRF conducts sessions to provide necessary
inputs to the staff of the partner organization. Along with the partner, they also
check out a plan of action for the following six month which the partner has to
take forward.
4.3.7.6
Partners meetings:
Partners meet twice in a year to update knowledge and skills. They share their
experiences and achievements and learn from each other. The partners meetings
are conducted region wise. Earlier CBR Forum used to host the partners meetings
but today the local partner hosts the same. At each meeting the host and the
location of the next meeting is decided with the consent of the CBR Forum. The
staffs of CBR Forum and a Board member are present in the meeting.
48
4.3.7.7
Research and documentation:
In the future is planning to have a research and documentation wing to conduct
research studies on disabilities.
4.3.7.8
Field Placement:
Another feature of the CBR Forum secretariat is that, the student and other
fellows from the organizations/institutions are being invited for a short term
period to conduct their study or create an understanding on disability and
Community Based Rehabilitation. In this process Mr.Chongtham Odessey singh as
a student of Social Work from the School of Social Work Manglore, Karnataka has
been completed his fellowship as a first fellow in the CBR Forum Secretariat.
49
CHAPTER FOUR
4.4 CBR experiences in the field: Planning, Monitoring
Evaluation and Capacity building in the CBR programmes
in the field.
4.4.1 Experience regarding the planning, monitoring, evaluation and
capacity building, in the field of C B R.
This is my personal field level experience in the field of the partner's organization,
where I learnt about the planning and monitoring through field exposure.
4.4.1.1
The Process of planning. Monitoring, and Evaluation been
divided in to following two parts.
1
One is at the CBR secretariats level. In this process CBR Forum plans for
the entire year with its staff members. The important feature of the CBR
Forum, both at the secretariat level and the implementing level,
participatory approach has been adopted.
At the secretariat level CBR Forum does the planning for its activities for
the whole year according to the Objectives. Every six months, CBR Forum
organizes a reflection meeting for the evaluation of the programmes, and
see that what is done and what is to be done in the next six months, and
plan of some new activities for the next year t, with he staff of the
organization
(The reflection meeting has done in the month of September 2006.)
(Refer annexure 4.1.1)
2 Another one is at the implementing agency level in coordination with
PWDs, families, and communities along with other staff members of the
organization. This is a very important feature of CBR Forum.
In this process the partners organizations does the holistic rehabilitation
under the guide lines (preparation of individual rehabilitation plan (IRP)
50
social and individual dimension) provided by the CBR forum. Through this
rehabilitation plans, CBR Forum ensure the holistic rehabilitation of persons
with disabilities in the community. This rehabilitation plan includes both
Social Rehabilitation Model and Plan and IRP Which focuses on the six
areas of growth of persons with disabilities at social and individual level.
4.4.1.2 Social Model of the Rehabilitation;
I
Physical model - ensure the health care services, their accessibility,
affordability, and quality for the persons With Disabilities.
II
Psychosexual - Personal Growth opportunities and clarify myth and
misconceptions regarding marriage and sex marital costumes in the family,
society, and the internal relationship with the family, peers, and the
community.
III
Intellectual level - educational opportunities for the persons with
disabilities, in both places family and the society, with barrier free and non
discrimination.
IV
Socio-cultural level - eradication of the negative attitudinal behavior of
social and family expectations, prejudice and beliefs, and good cultural
practices in the family and society.
V
Economical level - to provide opportunities for the economic gain, made
available by the family and the society.
VI
Spiritual - to promote the spiritual practices in the family and society.
Individual Rehabilitation Plan or Individual Rehabilitation Plan.
Individual rehabilitation Plan focus on the individual needs and prepares
the module under the six, Physical, Spiritual, Economical level. Socio
cultural level, Intellectual level. Psycho-sexual, areas of growth,
according to the need of the Persons with disabilities.
4.4.2
i
At the secretariat level:
The CBR forum has designed long term monitoring tools for the purpose of
the monitoring the model projects (Refer annexure 4.1.1)
51
2
programme officers pay fields visits ones in the six months to perform the
activities of monitoring and evaluation. (Refer annexure4.1.2)
Face wise indicators are developed by the CBR Forum for the each face,
3
are the key tools for the evaluation of partners organization.
4
The external evaluators suggestions are shared with the implementing
agencies by the secretariat.
5
The secretariat studies the report produced by the implementing agency in
the recommended of the CBR Forum during the field visits feed back will be
given to the partners organization.
4.4.3I
1
At organizational Level:
The organization implements the project as per the approved project
planner, and discusses the planner with the organization staff, community,
and families of the PWDs. Some of the monitoring and planning tools are
incorporated.
2
Key leaders are trained and sensitized to the issues of promotion ,
protection of disabilities and the rehabilitation in the neighborhood.
3
The organization staff members have trained the key leaders according the
approved planner.
4
The monthly targets have been fixed by the organization for the CBR
workers and the coordinators
5
The CBR. workers are expected to drive information from the field by their
first hand interaction with the PWDs, their families and communities. They
have to collected these information's by observation and formal interactive
meetings.
6
The indicators made by the implementing agency, will be the key factor
determines the directions of the projects, evaluate the expected outputs of
the projects and facilitate the organization to monitor the same.
52
4.4.4
Field exposure
Name of the organization: Center for Overall Development
Address:
Thamrassery Panchayat of Kazokode distt.
Persons contacted:
4.4.1 Back Ground of the organisation
C.O.D. (center for Overall Development) is working in three panchayats of
Kozhikode District, Kerela. The organization is implementing various
development programmes in Calicut District. The organiasation is
implementing the CBR project supported by CBR Forum in 03 panchaytas
namely Thamarasserry Panchyat, Marunkara Panchayat and
At field :-Through their survey, they have identified 444 persons with
different disabilities in the target area. COD follows the philosophy integrated
approach in implementation They have formed 175 (SHGsO, 350 persons
with disability have been integrated with the local SHGs. Out of 175 SHGs,
four (04) SHGs are formed exclusively for PWDs who are made as pressure
group in the future course of time. Now the organization has already entered
in the third phase of the project. During the third phase the team is going to
concentrate to build the capacity of the PWDs, their families and other
community members to take over possible responsibilities in the IV phase
onwards. It is expected that the dependency on the organization will be
reduced step by step in a steady and slow process. One of the concrete
strategies the organization has taken is identification, training and induction
of key leaders in the community. They are expected to carry forward the
programme with the facilitation of CBR team.
For this purpose
53
Planning for the next six months.
In the next session a regional meeting has to be conducted in the COD center
of Thamrassery Panchayat. In which all the regional members will come in
the C.O.D (Center for Overall Development) and will visit their field area
learn about the CBR programme, and share their experience and their
learning.
They will learn here the following things;
•
Duties and responsibilities of the CBR workers.
•
Duties and responsibilities of the coordinators.
•
Documentation of the organization.
How the organization is working for the Individual Rehabilitation Plan (IRP).
Here the CBR workers will play the role as a
> Facilitator
> Organizer and
> Catalyst
4.4.4.2
CBR Team
There is a CBR team including five (5) members two (2) CBR coordinators
and three (3) CBR workers. There I with programme officer Mr. Moses
Henck set with them for monitoring of their projects then I talked to them, on
the various issues and I felt that programme coordinator is new and he needs
for training, their field area is quite big and they have to cover a long distance
to meet the PWDs, so that they are including CBR in all of their activities and
other programmes. Like HIV/AIDS, awareness, water sanitation, and training
for key leaders so that they may able to take over the programme after some
time and will be able to work for the PWDs.
4.4.4.3
Capacity Building
54
The organization is working with its full strength for the rehabilitation of
persons with disabilities. And including the CBR in their various others
projects. It is helping PWDs to build their capacities to cope up with the
community and be able to manage their life with out any dependency. In this
context the organization is running a fan manufacturing unit for a sealing Fan
Company. This programme is giving the economical assistance and
empowering to the PWDs, and helping them.
Besides this programme, the organization is also giving the training to the key
leaders from the community and from the SHGs and builds their capacities to
take over the CBR programme at the end of this project. Their involvement in
the SHGs and other activities conducted by the organization shows the level
of their self-dependency and the empowerment increase.
Actually all the activities that are being conducted by the partners of the CBR
Forum, are a form of capacity building. Through these programmes the
organization is serving and building the capacities of the most poor, deprived,
and marginalized sections of the community in the rural areas. These
programmes are build the physical capacity, helps in the physical movements.
Intellectual capacity to educate them about their right and gather them to
demand from the society and govt, to include them in the main streaming
society, which helps for the behavioral change of the community and shows
their ability rather then disability.
4.4.5 Name of the organization : SANCHAR
Address:
Diamond Park, Joka, Kolkatta.(West Bengal)
Persons contacted Mrs. Tulika Das, and Goutam Choudhri.
55
4.4.5.1
Back Ground of the organisation
Sanchar is an organization or can be called a group of “Disability workers”
started working in the field of disability since 1988, with the poor people with
disability in the villages of South 24 Parganas with administrative and field
support from CINI (as a project of CINI - Child In Need Institute). They
carried out a survey of existing services for people with disabilities in the
three districts of West Bengal namely, North 24 Parganas, South 24 Parganas,
and Kolkata.
In 1989, the group started working primarily with the children with all types
of disabilities through community/home based programme in the village of
South 24 Parganas of West Bengal.
In 1990 the group registered as a society - SANCHAR A.R.O.D.(A Society
for Appropriate Rehabilitation Of the Disability)
With every passing year SANCHAR expanded its field to more and more
villages across the district and supported more and more people with
disabilities to be integrated in the main stream of the society. SANCHAR is
also working as a Resource support and training organization to promote
Community Based Rehabilitation approaches for mainstreaming people with
disabilities.
Other Features of SANCHAR are;
•
Working as a District Level Resource Organisation (West Bengal
District Primary Education Programme)(WBDPEP)
•
Joined Disability Activists forum - for amendments and speedy
implementation ofPWDAct. 1995.
As a part of the resource support activity SANCHAR act as a facilitation
center to provide the technical support to as many as 35 NGOs all over the
country through the CBR Forum.(Specially for the NGOs of the Eastern Region).
56
4.4.S.2
ORGANIZATIONAL DIAGRAM
GENERAL BODY
EXECUTIVE BODY
SECRETARY
DIRECTOR
I
Field Activities/CBR to ensure rights
Administration
of the people with disabilities
I
Field team: programme coordinator, field
coordinator, field supervisor
, field workers, vocational trainer
Resource teacher (29).
assistant
Accounts
others(3)
J
I
Accountant (2) Office
Family & Parents
Community
PWD
Home
Based
Programme,
Integrated
Education,
Community Mobilization, Parents
&
Adult
Disabled
Group,
Vocational Rehabilitation.
Resource Support Activities
I
Resource support team: programme officer (4), research assistant
(1)
r
Training
l
I
Publication Advocacy & Networking
1
Fund Raising
57
4.5.3
Activities for CBR programme
SANCHAR is carrying out various activities in the field for the community
based rehabilitation of person with disabilities. This is a type of community
health and community organization. That not only the family members,
relatives, and neighbors are realizing the problem of PWDs and their families,
but the whole community is being sensitized by the various activities of the
organization. These activities not only help to the PWD individually to spend
their daily life in a barrier free environment but change the attitudinal
behavior of the community towered the PWD in the process of social
inclusion.
Some of the programmes which are being carried by SANCHAR CBR
workers in the field are as follows;
4.5.3.1
Individual home / family based Management:-
As I mentioned earlier that SANCHAR is working for the peoples (children
and adult) with all types of disabilities. For each types of disability
organization takes up different approach in working with the concerned
person according to his/her needs. Individual Home based Programme (IHP)
depends on the level of impairment of the child / adult, his/her needs abilities
and limitations.
In this process the organization works in partnership with the parents and
families of Persons With Disabilities. CBR workers visit ones or twice a
week, does home based programme and follow up programmes to help the
parents and family members to learn the activities, by these visits one of the
primary intention of the organization is to build the capacity of the family so
58
that they can be an active part of the process. They are therefore expected to
continue the programme at home.
The IHP process starts with the support for the physical and mental/ social
development, if the child is delayed in his/her development. CBR workers
help the child being acquainted with the activities of daily living and
household. The children who have very low impairment and can be sent to
school helped by the pre- schooling activities and also help to develop their
communication.
4.5.3.1
Casestudy
________
Name
Sunny Mondal s/o Chandan Mondal
Villagae
Kolar Dhari
Intervention -
from April 2006.
Age
Mental Retardation
Visited
05
years
Impairment -
10/10/06
Targets
Concentration
Development,
Feeding,
Bathing
and
Dressing etc.
Status before intervention
Status After intervention
Before the intervention he was not After a continuous intervention of the
able to speak any thing even his CBR
workers Sunny Mondal
is
name. He could not identify letters learning the Activities of daily living
and numbers, lack of concentration to like, Bathing, Eating; he has the
perform the daily living activities. His movement problem in his hand so he
parents were unable to understand was not able before to eat rice it self,
about his behavior, then he heard CBR Worker gave some exercise tips
59
about SNCHAR came into contact of to his parents, and advice a regular
the CBR worker.
practice during the period of absence
of CBR worker. Now he is learning
bathing him self, movements is being
seen in his hand and he can eat and
can wear his half - pant him self in
sitting position.
Please see the Annexure ... 4.5.3.1... and for... photo and Individual Rehabilitation Plan
4.5.3.1
Case study
Name of the child- ASHIQUE GAZI,
Age
-
6 V2 year,
Parents
-
Jameela Bibi w/o late Mr. Kalo Gazi (father has died
before 2 month)
Village name
KALAGACHIA
Impairment
MR + CP
Type of intervention -
Individual Home Based Rehabilitation.
Duration of intervention - form last two year
Targets
(From July to September 2006)
Help the child to stand up
To make learn, or Help in the bathing activities.
To make learn dressing (wearing pant in sitting position)
To help the child in handfunctioning.
Feeding, especially in chewing food or meal.
60
ii
Status before
Individual Target
Before the intervention he was not able to do any thing. He used
After a long and continuous two years
to lying all the time was not able to move due to his spinal cat
problem.
intervention of the CBR worker he is
able to sit, on the special chair
provided by the organization.
Improvement in his condition is
taking place very slowly, but regular
interven tion of the CBR worker
through different activities is a hope
for his mother that after some time he
will be selfdependent, manage his
4
daily life activities. Because the
economic condition of his family is
not good, the chair is made by the
local resources available around
them it is very useful to teach him
various daily life activities,
Please see the Annexure ...4.5.3.1...and for...photo and Individual Rehabilitation Plan
4.5.3.2
Inclusive Education
One of the primary goals should be of every CBR organization to work for
the social inclusion, and integrated/inclusive education. The process of
inclusion of all children with whom organization is working is showing very
encouraging results.
The first step of successful inclusion is sensitizing and creating awareness
among the school authorities, teachers, and others students so that they
61
I i
genuinely support the process and understand the necessity and use of it.
Organization feels it is as much as necessary for the schools and others
children to be sensitize and prepare for integration of the children with
disabilities, inclusive insure the over all development of the CWds.
As a resource organization SANCHAR tries to provide necessary teaching
learning material support.
4.S.3.2
Case study
> *
Name Of the Person
Mafizul Mollah:
Village -
Amgachia
Disability -
Visual Impairment
Seventeen years old Mafizul is studying in class seven in the local secondary
school. His parents first identified his disability, at his age of one. Stricken by
poverty, his parents left no stone unturned to carry out all possible treatments,
for their child. However their efforts went all in vain. Out of sheer
helplessness and of course severe money crisis eventually they had to pull out
from their hard work At this critical juncture of his life, SANCHAR came to
know about Mafizul. He was then six years old. First, Mafizul was made
acquainted to his household items; mobility orientation was being also carried
out. Mafizul made their effort fruitful by learning all these within a year.
His training continued, and the subsequent division of training included counting, recognizing money, learning multiplication table and verbal solving
of sums. Other domestic activities like learning to wash his own clothes,
washing the utensil after having food etc. were also covered in his training
catalog. Mafizul successfully learned them within two years.
Sujit, a staff of SANCHAR, who himself is visually impaired, started
teaching Braille to Mafizul. In the year 1998, the effort started to admit
62
Mafizul to the primary school. It was an actual hard time for the parents and
the team of SANCHAR to convince the teachers. However, after a
painstaking phase of agreement and disagreement, the teachers were finally
won over. Mafi was admitted to the school. SANCHAR here took initiative to
organize and start teaching lessons from books of class I from Narendrapur
Blind Boys Academy, in the form of Braille.
Currently Mafizul is studying in Avoycharan local secondary school.
Organization certainly cannot foresee someone’s future, but till date his
steady progress, determination along with the support provided by
SANCHAR to overcome the hurdles of life, truly encouraged making this
integration a genuine achievement.
(Refer annexure 4.5.3.2 for the photo and his poem written in brail language)
4.S.3.3
Pre- vocational / vocational training and support for the
economic development.
After a certain age SANCHAR provide the training support to interested
individuals with disability. Organization is providing the help in terms of loan
or Seed money; contacts and support as and when required, so that the
individual or the group can gain confidence and start something on their own.
Organization primarily encourages inclusion of boys and girls with disability
in to some family trades that is convenient for the person to learn and also
helpful for the family.
This year the organization has arranged the vocational trainings for the
peoples with disabilities in tailoring, needle work, soft toys making, packet
and envelop making, and have ensured the conditions for the practice of these
vocations in their village community. Most of the PWDs are tries to involve
63
in their traditional, through which they can contribute much for the economic
development of their and their self.
4.S.3.4
Aids and appliances
Appropriate aids and appliances are one of the most important feature of the
organisation for mainstreaming of people with disability. Appropriate Aids
and appliances help in the general developmental of persons with disabilities,
with their, family and communities. These aids and appliances help in the self
dependency and mobility in the community, and built self confidence. They
under take one hand material in the surrounding area and when suitable,
modify the environment. In case of mobility aids like calipers, etc.
organization has been facilitating the procedure of helping those persons with
disabilities who are in need of avail services, which are accessible and
available around our base.
Types and aids provided to the PWDs.
KAFO
05
Extension Prosthesis
02
Crutch (Auxiliary modified at elbow)
02
Wheel Chairs
12
Special toilet Sitter
01
Special foot rest
01
Special Table and Chair
07
AFO
01
Sack foot
01
Tri-cycle
02
Special chair
03
64
Special Tables
02
Hearing Aids
14
4.S.3.4
Case study
Name
Anup Das s/o Amul Das, Roopa Das
Occupation -
Rikshaw
Villagae
kamagachi
Intervention -
from July 2006.
Age
4
1/5
year
Impairment -Hearing Impairment by birth Visited
Targets
-
Concentration
Development,
10/10/06
Feeding,
Bathing
and
Dressing etc.
Types of intervention
The Educational activities are being carries out for Anup das. He is being
helped to make straight lines, to identify the words, number name (his own
and Father/Mother), dot inclusion, drawing through matching dots
Just before one week he got his hearing aids there for hearing intervention in
the form of identification of different sounds and speaking practices are being
carried out.
After intervention
Now he can identify his name or parent name. He can fill the colour in the
picture drawn by him through the matching of Dots, identify the 1, 2, 3,
numbers. CBR worker is advising to his parents to admit him in the school
form the next year.
Problems — he is not interested to use hearing aids, he doesn 7 listen to his
parent, and always roams and don "t care him self. Because both his parent
65
work, they are not giving proper attention towards home based practices
therefore he is learning very slow.
| 4.S.3.5
(refer annexure 4.5.3.4)
Thursday - Open Day programme
[
On every thursday SANCHAR conducts the open day in its own premises.
This open day is a source to reach those unreached peoples with disability
who do not come in the field area of SANCHAR or still not being benefited
from the services of the organization. Through this open day clinic the
organization tries to help more and more PWDs, and their families to teach
them different life skills in order to help them in their home premises for
sustainability, and making their life easy and comfortable.
In spite of this intervention CBR workers visit their home for follow up
process and rapport building.
4.5.3.5
CCase study
Name
Hrit Rupam Shah,
Father
Narendre Nath Shah
Age -5/2 year
Mother
Barnali Nath Shah
Occupation- Police constable
Disability- Autism (HighperActive)
Since one year Hrti is getting regular intervention by the CBR workers of
SANCHAR. Always his mother comes with him. He is a very active boy even
one minute he can 7 sit in a single place.
Objective: -
To reduce the level of highper activism and to develop the concentration,
through different activities, and try to teach about the things around them.
Intervention: -
66
Practicing of matching different kind of toys, putting heeds into the pot,
coloring in the picture and different circles. Mother is being taught through
the CBR worker that in the home daily living activities should be in the
regular practice. She can comes every week and consult their problem which
she face during the week.
Previous condition:Due to his high per activism he was not able to sit, he jumps and moves, he
can nto remove his trouser himself before toilet activities and not put on him
self often.
After intervention: -
After the intervention of CBR worker through Open Day programme he is
able to do his saily living activities like toilet, bathroom, dressing, eating, but
progressing very slow, so the CBR worker is doing regular counseling of her
mother to give proper attention, and trying to play some teaching Games
suggested by the CBR woker.
4.53.6
------ -— ____
Status of the organization working with PWDs
NO. Of PWDs getting benefited by the Community Based Rehabilitation
Programme. Now the organization is working in more then 100 villages of
South 24 Parganas, district, with 760 persons with disabilities, for the
community based rehabilitation programme.
Status or Work
No. of Villages - 100
No. of PWDs
- 760
No. of families - 735
Persons with disabilities, age wise distribution, in the field area of
SANCHAR.
67
Age group
>0-5 yrs
5-10 UTO-;
16^ -.:yr^.>
Natureof
L8T;M8t40 yr^
! 15yre ■ Tyrs ;- r ■
401
Fotal
?yrs?
Grand
Total
F
M
3
4
6
10 17 24 09 29 43
99
12 30 90
196 286
0
1
02 00 03 02 01 01 05
14
02 03 13
21
34
12
M
6
F
s
Disability
Locomotor
Disability
Visual
Impairment
Hearing
00 01
10 14 16 07 11
32
28
01 03 66
69
135
04 00 10 14 08 16 07 10
17
33
00 02 46
75
121
04 03 07 17 10 19 03 05 08
26
00 00 32
70
102
Epilepsy
01 00 00 01 04 02 07 05 29
31
00 02 41
41
82
Total
12 09 37 52 56 79 34 61
Impairment
Mentally
Challenged
Multiple
Disability
Grand
21
89
135
95
134 231 15 40 288 472 760
365
55
760
Total
1
Sanchar annual report 2005-2006
Gender Distribution of person with disability in the field area.
Natureof Disability
Male
Female
Total
Locomotor Disability
196
90
286
Visual Impairment
21
13
34
Hearing Impairment
59
66
135
Mentally Challenged
75
46
121
Multiple Disability
70
32
“102
Epilepsy
41
41
^80^™^”
Total
462
^288
760
68
4.06 Resource support activities
Like a resource group every year SANCHAR conducts various activities in
the field of CBR at individual level and organizational level. Mainly the
organization is supporting or carrying out four types of activities like,
training, Publication, Networking & Advocacy, and fund raising.
4.07 Training:
SANCHAR is a training center for the partner organizations of the CBR
Forum, and for CAPART (Council for Advancement of Peoples Action and
Rural Technology) to train the programme coordinators and field workers
who are will or who are working in their respective field areas. This is goes
for 40 days through out the year divided in three phases.
First phase of training consist in 15 days training, the main focus of this
training is the identification of the of person with disability, it involves:
1
Introduction of disability with the Identification.
2
Concept of Community Based Rehabilitation.
3
Causes and Prevention of disability
4
Locomot disability
This training is done through field visits and class orientation.
After this training the organization conducts two days orientation programme
for the Board of members of the partner organizations, to sensitized them
toward CBR and its importance.
After this programme the second phase of training for 12 days comes for only
the coordinators of the partner’s organizations, to make them understand their
rolls and responsibilities, towered CBR, PWD Act 1995, and various schemes
of Govt, and other organizations.
69
Third phase of training comes for 18 days, after finishing the second phase. In
this phase organization Again they calls all the coordinators and CBR
workers, with their all the documents, to review and reflection of their
experience regarding CBR.
The Training staff of Sanchar visits in the field of the partner organizations
for 7 days, between 15 and 18 days training of the partners organizations, to
help and look for their activities, and gives necessary inputs. These 7 day:s
training is the part of 42 days training programme through out the year.
4.08 Publications
SANCHAR also work on publication. There are numbers of Magazines and
Books in English and other languages on the disability published by the
various publications, but very few efforts have been made in Bengali
Language. So the Publication of Aanya Bhovan (Another World) is a great
effort develops the understanding of Bangali reader’s toward disability. This
is a Quarterly issue, contain various topics regarding disability. In every
quarter one issue is raised through the magazine and different articles are
being written down through the experts. This magazine includes Life cases
histories, books for the readers who want to know more regarding a given
topic. Brail version of this magazine is also available in Bengla language, by
the effort of Sujit Karmakar a visually challenged person in SANCHAR
staff.
Besides this the annual report is also being published by the SANCHAR
contain different activities case histories, support, and financial statements for
the year. In spite of all these things different leaflets and written material got
published from time to time.
(Refer the annexure 4.08, for the magazine)
70
Advocacy & Networking
4.4.09
•
M
In the field of advocacy and networking SANCHAR is involved on
various level with govt, and other developmental organizations, and
working more then 40 ODOs (other Developmental Organisations) on
the developmental and disability issue. Like SANCHAR is the member
of State Resource group (SRG) for the integrated education for
disabled.
Sanchar is working as a district level resource group
•
SANCHAR is one of the active members of the Disability Activists
Forum.
•
State and district level member of Sarva Shiksha Abhiyan.
•
Member of SWASTHA — a West Bangal network & initiative on
women’s heath.
•
Member of network and campaign to Stop Violence Against Women
and Girls.
Beside this a continuous network groups SANCHAR is involved to enforce
the implementation of PWD Act 1995, on the respective govt, authorities.
4.4.10
Funding
There is a long list of the funding organizations that are supporting to the
activities of SANCHAR in the respective field. Donation from MIBLOU,
Switzerland for administration expenses, vocational training programmes.
Donation from Doundation Lord Michelham for hearing aids.
Donation from Mrs.Baldwin, London for visual disability project, donation
from
local
resources,
district
primary
education
programme,
research/projects, fund raising, consultancy etc.
71
CHAPTER FOUR
A
4.5.1
■r
■
-
■
:
■
?
:y and CBR ~
MY UNDERSTANDING ABOUT ADVOCACY:
ADVOCACY as I understood from my field experience, is a process that
ensures that the rights of vulnerable people are protected, that their self
defined needs are met, and that they are supported to make decisions that
affect their lives. It is also a vital component of patient protection, assuring
that the vulnerable person's legal and human rights are respected, and that
their self-determination, independence and autonomy are maintained.
"Advocacy” is a positive approach; it emphasizes a person's capacity for
autonomy and ability. Particularly it offers assistance in understanding the
options available, and in communicating personal preferences to others. In
cases where a vulnerable person cannot instruct an advocate and is at risk of
abuse or neglect, an advocate's intervention may be seen as "protection."
Hence, this dimension of "protection" is included within the concept of
"advocacy." It is a wining people’s heart, by their favoring and doing some
thing through a legal way it a fight for the rights of the most vulnerable
peoples in the community. It is a process to gather people and make people
aware of their rights duties and responsibilities.
It could be defined by many ways but it could be briefly defined as an action
in the community through its legal roots.
4.5.2 HISTORICAL CONCEPT OF ADVOCACY
Most of the people think that Advocacy is a new thing, but in my opinion it is
not right. We can accept it as an emerging concept but not new one. We
could see its existence right from the beginning - Whether it could be the age
72
of the emperors or earlier period of industrial revolution in the Europe or later
one. In every time advocacy existed in different forms.
In the ancient period or time the king were listen to the voice of their citizens
about their rights and duties what had to provided by the king in their
kingdom. Their common citizens could bring their problems and complaints
if some one violated their rights. It was a kind of individual advocacy.
After this from time to time the concept has been converted in various ways
or forms and took different shapes. Advocacy can be done individually or
together against their violation of rights or illegal custom and traditions to
protect human being and promote self-confidence in participation in the
society the kind of advocacy since the early period. For instance, Raja Ram
Mohun Roy movement against the wrong customs and traditions and
especially against Satipradha, Mahatma Gandhi’s movement against
untouchabilty and , Bharat Chodo Andolan and breaking Salt Law in India
and non discrimination movement in South Africa are a successful type of
advocacy which is being conducted since earlier periods of this millennium.
It’s has been proved that the process or concept of advocacy is not new but it
is changing from time to time and now its in pure form.
4.5.3
CBR AND ADVOCACY
As it had mentioned before that the CBR is a holistic rehabilitation process
done by the combined efforts and involvement of PWDs, family and the
community members. It existed and practiced by the community and the
family members in an informal way for centuries. Community based
rehabilitation gained formal recognition and worldwide acceptance after only
with its promotion by the World Health Organisation and other UN Agencies
in early 80’s. It was since promoted in a suitable method of rehabilitation of
PWD’s with and within the community level. The term of CBR has assigned
73
to numerous concepts yet one way to understand CBRs as a group process
and in this group process we are looking after the goals that are expected to
achieve and these goals are also the part of advocacy like
1. How much we can create awareness or through the person with
disabilities on the issued on their rights, responsibilities, their full
participation in the community through the barrier free environment,
change the attitudinal awareness about their ability, capacity and
creativity?
2. How much we can enhance the capacity or activity of daily life of
PWDs?
3. How much we can make them motivate and educate towards their
rights and entitlement given by the legislation?
4. How we can make cohesion of PWDs with the mainstreaming society,
to demand for their rights, Public Health Services and other services
not completely met by the Government or the local authority?
If we look at all the above questions, we will find that advocacy is the
appropriate tool by which we can achieve the desired goals, objectives or
priorities decided by the community or person with disability for their full
inclusion and participation with their abilities in the main streaming
society. As Science has its laboratory for experiment to get the desired
results, the CBR is the laboratory for advocacy science.
4.5.4
NEED OF ADVOCACY IN CBR.
In the course of the time welfare services were provided by the
organizations in the sense of the charity and pity for their state of isolation,
or segregation. But by the time and especially since the 80’s the concept of
74
Rehabilitation is becoming much stronger and gradually shifting its
paradigm from institutions to the community. As CBR expands from the
small to the large icon, new researches and the advocacy issues raising and
demanding for their rights will be the driven force to take the new
initiatives. Now gradually more and more paradigm are shifting and the
greater importance is being given to the Policy Development, Programme
Planning, Monitoring, demand of the good and efficient structure, result
oriented and right based public policies. These are opening the ways for
the Advocacy for the community and especially in the field of CBR.
The issues demanding advocacy are the attitudinal and the behavior of the
community, inaccessibility and environment with a lot of barriers for the
persons with disability and the society, their discrimination and isolation
within the community, Economical backwardness or poverty, lack of
accessibility of the public health services and expensive private health care
systems, Exclusion from the mainstream society. These issues have lead
the organizations and the individuals to take of activities of advocacy in a
vigorous manner. This is aiming at protecting and demanding for their
fundamental human rights and entitlements given by the legislation, which
is giving the greater, emphasize to the need for Advocacy
455
c'*.
—Stepsin
Adv<
Before analyzing the steps involved in the ‘advocacy’, it is worth
understanding the concept of Advocacy. AS it is mentioned before that
advocacy is the a kind of favour or to work for some one through legal action,
it could be individually or together. It dose not define or favour for the
particular things but it takes into account all the persons together and work
for them.
75
In the community Based Rehabilitation we demand for the inclusion of
persons with disability, so when we talk about advocacy in the CBR
programme, we talk about issues of common interest or problems faced by
the local, poor and marginalized persons of the community. It calls
mainstreaming advocacy concerned not only with the Persons with
Disabilities but the whole community.
4.5.5.1.
Location and Identification of issues)
This is the first step of the Advocacy. In this step the problem identification is
a major task, these problems should be concerned to the community, but it
should be looked that how much the persons with disabilities are affected
from the problem.
The easiest way to find out and frame an issue is in the form of a question.
Try to create public opinion about the problem.
For instance
1) Problem- for Persons with disabilities to get medical certificate.
It is not easy
Issue - Is it not a duty of the State/ District administration to ensure
persons with disabilities get their medical certificate?
2) Problem- Public toilets are not accessible to disabled people
(cross disability)
Issue - Is access to public facilities a violation of disabled peoples' rights?
3) Problem- In school, the teachers did not allow a child who has physical
impairment to
take part in sports.
Issue- is there not a duty for the teacher to treat children equally and with
respect and dignity?
76
4) Problem - persons With Disabilities are not getting the power connection
they have to pay more for the electric line from the pole to their house.
This is a common problem in the rural areas. Often electric polls dose not
situated near the every ones house.
Issue - it is the duty of the govt, to provide single free connection
4.5.S.2
Establish Goals
Next step after the identification of the issue is to establish the goal, that what we
want to do by this problem; what is our objective to achieve by the advocacy of
the problem.
What do we want? Or what could be achievable easily goal.
1. What are our achievable goals?
2. Identify short-term goals
3. Identify long-term goals, if necessary
Prioritize the goals. Deal with the urgent ones immediately. Then deal with and
plan strategies for the rest. The goals have to be simply stated, list just those that
can be handled and most importantly they have to be feasible.
4.5.5.3 Framing The Probl em
The framing of the problem teach about the causes of the problem, that
what is the real cause of the problem. This section asks about the
following question.
•
What is the problem?
•
Where did it occur?
•
When did it happen? Is it a one time thing or a recurring problem?
•
Who were the violators or people who can help, do something about it?
•
How did this all come about
1. Identify your stand and position on it.
77
2. Say your short term and long -term goals. Short term and long goals should
well define and listed. It helps to set the priorities and to take action according
it.
4,5.5.4
Social Mobilization
Social mobilization is the most important tool of the Advocacy. This is the
only way that full fill the concept of CBR and ensures the community
participation and the maximum use or utilization of the available resources.
The value of this step of "social mobilization" is to show that people need to
work together. This is the feature of the CBR that it involve the community in
every work of common goal and motivate to take necessary steps whether it,
Advocacy or other mobilization toward the community welfare.
Coalitions, Networking and Mobilization of people
1. Organize on the basis of issues or disability.
2. Connect with people from cross disabilities.
3. Make up for each other's limitations and supplement each other's work.
4. Meet regularly and have a good reporting system between groups.
5. Network with other social organizations and grassroots groups.
6. Be involved with other issues; women’s rights, children’s rights,
tribal/adivasi movements.
7. Speak and communicate with Government officials, media people,
teachers, professionals, corporate sector, etc.
8. Assess who are friends, fence-sitters, opponents.
[4 5'5 5
Different tactics for different target group^
Speak about the different groups and the skills required from each.
Legislative - lobbying, questions in parliament.
Courts -Public Interest litigation, criminal complaints, civil remedies
78
Police - Sensitize police persons
Bureaucracy - Meet the good guys, keep a list of people in various
departments and ministries - central and state - names and numbers.
Some of the Key strategies and action
Advocacy is a pro-active, planned and co-coordinated action. With practices,
one should be able to anticipate events/ problems before they actually occur.
• Spreading awareness in public and among leaders, and create public
opinion
• We should be aware about, Acts, Rights and Duties, given in the
legislation or providing by the appropriate govt, understanding the real
situation of person with disability or understanding their feeling is
more important task while working toward Advocacy.
• Media action - give information to public media
• Submit petitions, letters and memorandums to officials
• Lobbying with legislators and others, to raise the issue at a suitable
forum
• Network and coalition with a wide variety of groups, organizations
with whom a common working understanding can be reached. With
this coalition we try to ensure that the group who are working in
different fields can come together for the common causes, like
• Demonstrations, protests, dhamas, etc. are the main and important
practical action shows or shore that people against the violation of their
rights cant take any kind of action, and have a common plateform.
•
Filing Public Interest Litigation (PIL)
(Steps of Advocacy are Mr. C. Mahesh and Mr. Chandru’s notes of Advocacy and CBR)
79
5.6
Conclusion
In the developmental field every task consist in process, and process takes a long
time to be completed, and some time it completed very fast. The success of the
advocacy process is depends on the strategies, and the programme is prepared by
the group. The identification of the problem is a very important task and with out
that it is difficult to take any step forward for anything. Advocacy is a down to top
process like a small plant grows up to tree. Every problem in the community
creates scope for the advocacy, need is to identifies the problem, measure that
how much a persons or the communities are suffering from that. It becomes more
helpful for the integration of the persons with disabilities in their families and
community. If the person with disabilities comes together and raise their voices
for the common issues, it will show their ability activity and mobility, rather then
disability.
80
CHAPTER FOUR
Back ground of the PWD Act.1995____________
4.6.1
The persons with disability (equal opportunity and protection of rights and full
participation) Act 1995.is a milestone in the field of disability. I think this is the
first Act, talks about the rights and entitlements of persons with disabilities and
provides the opportunity to them to participate in the community with their full
potential and abilities.
I think that the Act is works on following three levels -
1
Governmental level (official)
Public level, and
3
Non governmental
1 Governmental level (official) - At this level the role and responsibilities of
the govt, toward the rights of persons with disabilities, formation of central
level and State level coordination committees, district level rehabilitation
centers and involvement of the Govt, and the civil societies at various level
with and with out the govt, has defined. This Act takes into account
implementation of the Act, and takes legal action against the violation of
the rights of Persons with disabilities.
2 Public level - the Act provides the rights and opportunities to the persons
with disabilities for their equal participation with full potential and abilities,
stop non discrimination in the community and public health services,
departments, and structure, provides barrier free environment, reservation
in employment, and relaxations in the various schemes and programme.
3 Non governmental level - at this level Act provides the assistance, both
financial and official and recognition to the institutions and the
organizations working in the field of disabilities, mean while this Act has the
provision of research and the manpower development for the persons with
disabilities and establishment of new institutions to enhance capacity,
mobility and participation of persons with disabilities.
But beside all of these features still this Act is unable to full fill the
requirements of the persons with disabilities. Actually the problem starts with
the certain kind of attitudinal behavior of Non disabled persons toward, the
personas with disabilities. This attitude makes to the PWDs more disabled than
they are. Up to some extent the word disability also creates a kind of stigma
that the persons who are being addressed by this word has certain kind of
disability, rather then abilities, so the need is to call them persons with
different abilities.
Other reasons of failure, what I think, is that, lack of the monitoring of schemes
providing by the government. Lack of responsibilities of the governmental officers,
lack of awareness regarding the rights provided in the persons with disability Act
1995, to PWDs, lack of information regarding the implementation of the Act, are
some causes contributing in the failure of the Act, and stopping us to get desired
results.
2
81
4.6.2
Back ground of the UN convention on Disability^
In the late 60s and 70s, people with disabilities started demanding rights, inspired
by the civil rights and women's rights movements. The declaration of a UN
international year of disabled people in 1981 was the beginning of a new
international era in the disability movement, as it sent a strong and important
message to the world. In 1982, the UN World Program of Action, a resolution
aiming to improve the living condition of people with disabilities, was a milestone
in raising international awareness.
UN International Decade of People with Disabilities 1983 - 1992 challenged the
world's nations to implement plans to improve the living conditions for people with
disabilities
In 1999, RI proclaimed the Charter for the New Millennium where it "calls on
member states to support the promulgation of a United Nations Convention on the
Rights of People with Disabilities." The Charter also says that "Community
Based Rehabilitation should be widely promoted nationally and
internationally, as an affordable and sustainable approach to services.
(article by Tomas Lagerwall
Tokyo, June 8, 2005)
Seven UN Ad Hoc Committee meetings have been held since July 2002, and a
majority of the world’s nations and several international NGOs are now working
together for a UN disability convention. I think that within few more years,
countries will have introduced necessary amendments in their legislation and will
make the policies to ensure the development, and equal participation of the
persons with disabilities
. It will then be up to all of us to make sure that
governments ratify and implement the convention and ensure that the convention
is well-known and used all over the country and the world.
And finally the 8th Ad Hoc Committee meeting complete from 14 to 24 august
2006 in NewYork. The objective of this meeting is that to prepare the final draft
on the rights of persons with disability. 8th Ad Hoc committee has suggest many
thing and rights based approaches for the persons with disabilities, and the all
signatories bodies to implement it as soon as possible.
Health is a fundamental Human Right. As a community health worker I would try
to suggest here some right-based approaches in the Persons with Disabilities
(equal opportunity and protection of rights and full participation) Act
1995, in the light of 8th Ad Hoc committee draft in the UN convention on
the rights of persons with disabilities. These suggestions are also based on what I
felt during my field visits in different CBR programmes and discussions with my
mentors.
82
PWD ACT, 1995
THE
PERSONS
WITH
DISABILITIES________
PREVENTATION
AND
EARLY DETECTION OF
DISABILITIES
S111 Ad Hoc Committee Suggestion
and
DRAFT CONVENTION
amendments / read it as
ARTICLE
8
AWARENESS-RAISING
Preventation and early
Detection of Disability in
child Women and Girls.
1. States Parties undertake The state parties shell adopt
measure
to
25. Within the limits of their to
adopt
immediate, appropriate
economic
and effective and appropriate identifying and preventing the
capacity
cause of disability.
development, the appropriate measures:
The
state parties shell Governments and the local
a)
Take
action or into account
authorities, with a view to (a) To raise awareness
preventing the occurrence of throughout
society, the protection and promotion of
disabilities, shallincluding at the family human rights of Person With
level, regarding persons Disability in the sense of right to
(a) Undertake or cause to be with disabilities, and to health care and legislation will
undertaken
surveys, foster respect for their ensure that not any PWD women
and should be discriminate on
and research rights and dignity;
investigations and
the
basis of religion cast, race,
concerning the cause of
color,
and specially on the basis
occurrence of disabilities;
(b) To combat stereotypes,
prejudices and harmful on disability.
(b) Promote various methods of practices relating to persons B) the state shell recognize that
preventing disabilities;
with disabilities, including no women and girl with
disability should discriminate on
those based on sex and
the
basis of disability of any
© Screen all the children at least age, in all areas of life;
kind and the protection and
once in a year for the purpose of
promotion
of the human rights
identifying “at-risk” cases;
and
fundamental
freedom and
©To promote awareness of
(d) Provide facilities for training the
capabilities
and their full enjoyment security in
to the staff at the primary health contributions of persons the legislation by policy making
should be the prim responsibility
centers;
with disabilities.
of the state government.
c) state parties should adopt
2. Measures to this end appropriate legislative measures
for the accessibility of the health
(e) Sponsor or cause to be include:
care services for the women and
sponsored awareness campaigns
girl
with disability.
and is disseminated or cause to (a)
Initiating
and
d)
free education up
up to
be disseminated information for maintaining effective public
will
be
general hygiene. Health and awareness
campaigns graduation
accountability,
and
provide
and
sanitation,
designed:
engage them in appropriate
(f) Take measures for pre-natal, (i) To nurture receptiveness income generation activity will
parental and post-natal care of to the rights of persons with be responsibility of the state
parties. And to promote these
mother and child;
disabilities;
activities appropriate policy and
programme
will be make by the
(g) Educate the public through (ii) To promote positive
the
pre-schools,
schools, perceptions and greater state govt.
E) state parties shell take
83
primary health Centers, village social awareness towards
level workers and anganwadi persons with disabilities;
workers;
(iii) To promote recognition
(h) Create awareness amongst of the skills, merits,
the masses through television, abilities and contributions
radio and other mass media on of persons with disabilities
the causes of disabilities and the to the workplace and the
preventive measures to be labour market;
adopted;
(b) Fostering at all levels of
the
education
system,
including in all children
from an early age, an
attitude of respect for the
rights of persons with
disabilities;
(c) Encouraging all organs
of the media to portray
persons with disabilities in
a manner consistent with
the purpose of the present
Convention;
(d) Promoting awareness
training
programmes
regarding persons with
disabilities and their rights.
appropriate measure to ensure
the full and overall development,
advancement, settlement, and
empowerment, of women for the
purpose
of exercise and
enjoyment of Human rights and
fundamental freedom.
for the enjoyment and
exercise and enjoyment of
fundamental freedom
- For
the
participation
protection and promotion of
Political freedom state parties
should reserve the seats for the
women with disability in
Gram
Panchayat,
Nagar
Panchayat and Ward Member
Election.
- Govt, will promote SHGs of
PWDs (especially women’s) at
every level and will take
appropriate to come together in
the case of denial of their social,
cultural, political, economical,
and other fundamental Human
Rights.
For the girls with disability
appropriate state and center level
govt, should make provision to
select girls with disability to take
part in the community as a
“ASHA” workers under the
National Rural Health
Mission.
The State parties will
protect any kind of denial like,
human and Fundamental rights,
discrimination in education,
employment and rehabilitation,
violence at work place and any
kind of Physical, mental, sexual
harassment, against Girls with
disabilities.
Children with disability,
the state parties shell
take
appropriate measure to full
enjoyment and participation of
Human and fundamental rights
84
State parties shell make
policies and take legislative
measures to stop of child labour
for child with disability.
(Article 7) - State shell be
responsible for the appropriate
habilitation and rehabilitation of
CWDs with the parents and
within the community.
(Article - 15) - no one will be
subject to inhuman or cruel
torture or degrading treatment
and
punishment
especially
persons with disability.
CHAPTER
EDUCATION
V ARTICLE
EDUCATION
26.
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;
24
1. States Parties recognize
the right of persons with
disabilities to education.
With a view to realizing this
right without discrimination
and on the basis of equal
opportunity, States Parties
shall ensure an inclusive,
education system at all
levels,
and
life-long
learning, directed to:
(b) Endeavor to promote the
integration of students with (a) The full development of
disabilities in the normal the human potential and
sense of dignity and self
schools;
worth, and the strengthening
© Promote setting up of of respect for human rights,
special
schools
in fundamental freedoms and
diversity;
Government and private human
sector for those in need of
special education, in such a (b) The development by
manner that children with persons with disabilities of
disabilities living in any part their personality, talents and
of the country have access creativity, as well as their
mental
and
physical
to such schools;
abilities, to their fullest
Suggestion or
Amendments
Education
is
a
fundamental
Human
Right.
1. Appropriate govt, at the
central and state levels
should ensure equity, non
discrimination and barrier
free
environment
and
recognize the rights of
PWDs
with
inclusive
education system at all level
with life long learnings
directed to a) The full development of
Human potential and
the sense of dignity self
worth,
strengthening
the respect of Human
rights
fundamental
freedoms and Human
dignity.
b) The development of
personality talent and
creativity as well as
85
(d) Endeavor to equip the potential;
special schools for children
with
disabilities
with (c) Enabling persons with
vocational training facilities. disabilities to participate
effectively in a free society.
27.
The
appropriate
Governments and the loca
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 parttime classes for providing
functional
literacy
for
children in the age group of
sixteen and above;
© 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
equipments needed for his
education.
2. In realizing this right,
States Parties shall ensure:
a) That persons with
disabilities are not excluded
from the general education
system on the basis of
disability, and that children
with disabilities are not
excluded from free and
compulsory primary and
secondary education on the
basis of disability;
(b) That persons with
disabilities can access an
inclusive,
quality,
free
primary and secondary
education on an equal basis
with
others
in
the
communities in which they
live;
©
Reasonable
accommodation
of the
individual’s requirements;
(d) That persons with
disabilities
receive
the
support required, within the
general education system, to
facilitate their effective
education;
(d) bis That effective
28.
The
appropriate individualized
support
Governments shall initiate measures are provided in
physical and menta
ability to their ful
potential.
c) The purpose of the
education should be
Enabling to the PWDs
to
participate
in
decision-making
planning
implementation
and
monitoring fully anc
effectively in a free
society. The appropriate
govt.
ensure
the
necessary changes in
the syllabus of persons
with disability
2
Govt, and local
authorities : a) Ensure every child with
disability have equal
access to inclusive, free
primary and secondary
education on the equal
basis with others in an
appropriate and barrier
free environment in the
mainstreaming schools
in the community in
which they are living
without
any
discrimination.
b) Ensure that PWDs
should not be excluded
from
generale
education on the basis
of their cast, class,
‘religion, race, and
especially on the basis
of disability.
c) Endeavor to promote
the integration and
reasonable
accommodation on the
individual’s
requirements of the
Person With Disability.
d) Ensure that the PWDs
86
or cause to be initiated
research by official and non
governmental agencies for
the purpose of designing
developing
new
and
assistive devices, teaching
aids,
special
teaching
materials or such other
items as are necessary to
give a child with disability
equal
opportunities
in
education.
environments that maximize
academic
and
social
development,
consistent
with the goal of full
inclusion.
and especially CWD
(children
with
disabilities) will receive
the required support
and assistance with anc
within the general anc
special
education
3. States Parties shall enable
system, to facilitate
persons with disabilities to
their
effective
learn
life
and
social
education
and
development
skills
to
vocational trainings.
facilitate their full and equal e) The state govt, make
participation in education
appropriate
and
and as members of the
effective policies and
29.
The
appropriate community. To this end,
programmes at every
Governments shall set up States Parties shall take
level for the special
adequate
number
of appropriate
measures,
education
and
teachers’
training including:
schooling
for
the
institutions and assist the
children with disability
national institutes and other
with appropriate prevoluntary organizations to (a) Facilitating the learning
vocational training and
develop teachers’ training of Braille, alternative script,
will
include
pre
programmes specializing in augmentative
and
vocational training as
disabilities so that requisite alternative modes, means
an
integrated
trained
manpower
is and
formats
of
component
of
the
available for special schools communication, orientation
special
education
and integrated schools for and mobility skills, and
syllabus.
children with disabilities.
facilitating peer support and 3. State govt, enable PWDs
mentoring;
to learn life and social
development
skills
to
facilitate their full and equal
30. Without prejudice to the (b) Facilitating the learning participation
in
the
foregoing provisions, (be of sign language and the education as a effective and
appropriate
Governments promotion of the linguistic respected members of the
shall by notification prepare identity
of
the
deaf community. To this end
a comprehensive education community;
state parties take appropriate
scheme which shall make
measure including:
Provision for©
Ensuring
that
the a) Facilitating the learning
education of persons, and in
of Braille, alternative
(a) Transport facilities to the particular children, who are
script,
augmentative
children with disabilities or blind, deaf and deaf-blind, is
and alternative modes,
in the alternative financial delivered in the most
means and formats of
incentives to parents or appropriate languages and
communication,
guardians to enable their modes and means
of
orientation and mobility
children with disabilities to communication for
the
for
skills, and facilitating
attend schools.
individual,
and
and
in
peer
support
and
environments
which
mentoring;
The
removal
of maximize academic and b) Facilitating the learning
(b)
87
architectural barriers from social development.
of sign language
schools. Colleges or other
and the promotion of
institution,
imparting
the linguistic identity of
vocational and professional 4. In order to help ensure the
the deaf community.
training;
realization of this right,
4. In order to ensure the
States Parties shall take
© The supply of books, appropriate measures to protection and realization of
state parties uniforms and other materials employ teachers, including rights
a) Take appropriate measure to
employ teachers including those with
to children with disabilities those with disabilities, who
disability who are qualified in Braille
attending school.
are qualified in sign
and other sign languages, and to train
professionals and the staff who are
language and Braille, and to
working in the field of education.
(d) The grant of scholarship train professionals and staff
to students with disabilities.. who work at all levels of b) Setup adequate numbers
education. Such training
(e) Setting up of appropriate shall incorporate disability
of teachers training
fora for the redressal of awareness and the use of
grievances
of
parent, appropriate
institutions and assist
augmentative
regarding
and
alternative
modes,
the placement of their means and formats of
the national institutions
children with disabilities;
communication, educational
and others voluntary
techniques and materials to
(f) Suitable modification in support
persons
with
the examination system to disabilities.
organizations or
eliminate
purely
develop teachers
mathematical questions for
the benefit of blind students 5. States Parties shall ensure
training programmes,
and students with low that persons with disabilities
vision;
are able to access general
specializing in different
tertiary
education,
(g)
Restructuring
of vocational training,, adult
types of disabilities
curriculum for the benefit of education
and
lifelong
1
children with disabilities;
learning
without
fields so that requisite
discrimination and on an
equal basis with others. To
trained human resource
this end, States Parties shall
ensure
that
reasonable
including PWDs could
accommodation is provided
to persons with disabilities.
be available for the
special schools,
integrated mainstream
schools with inclusive
education and barrier
88
free and non
discriminated
environment, for the
children with disability.
d) Reasonable accessible
and
barrier
free
accommodation
and
reservation
in
the
accommodation must
be provided by the
govt, as per need of the
person with disability.
e) Govt, by notification do
necessary adjustment
according to the Need
of
Persons
With
Disability,
in
the
structure of all their
departments or public
places,
like
health
institutions, education
institutions, and in all
others
governmental
and non governmental
institutions funded fully
or partially and to be
funded by the govt, for
the
maximum
accessibility,
and
enjoyment of Human
rights. Intervention of
the PWDs in bodies to
these
implement
measures.
f) To
monitor
the
state
implementation
govt, with the help of
the district and block
panchyats, form the
local bodies of PWDs
including their family
members or others
members
in
the
community, at the gram
89
CHAPTER
EMPLOYMENT
panchayat level.
VI ARTICLE 27 - WORK EMPLOYMENT
AND EMPLOYMENT
1. States Parties recognize Article 27
32.
Appropriate the right of persons with (Following are the sdditional inclusion
from the UN Adhoc Suggestions)
Governments shall—
disabilities to work, on an
(a) Identify posts, in the equal basis with others; this
establishments, which can includes the right to the 31. State parties will
be reserved for the persons opportunity to gain a living recognized the right of
with disability;
by work freely chosen or persons with disabilities to
(b) At periodical intervals accepted in a labour market work on equal basis with
not exceeding three years, and work environment that others; this include the rights
review the list of posts is open, inclusive and of the opportunity to gain a
identified and up-date the accessible to persons with living by work freely chosen
list taking into consideration disabilities. States Parties or accepted in a labour
and
work
the
developments
in shall safeguard and promote market
technology.
the realization of the right to environment that should be
inclusive
and
33.
Every
appropriate work, including for those open
accessible
to
the
PWDs.
Government shall appoint in who acquire a disability
every establishment such during the course of State shell recognized the
percentage of vacancies not employment, by taking right to work including for
less than three per cent, for appropriate steps, including those who acquired the
persons or class of persons through legislation, to, inter disability during the course
of employment by taking
with disability of which one alia:
appropriate steps including
per cent, each shall be
reserved
for
persons (a) Prohibit discrimination through legislation to inter
suffering fromon the basis of disability alia;
(i) Blindness or low vision; with regard to all matters
(ii) Bearing impairment;
concerning all forms of (a) Prohibit discrimination
(iii) Loco motor disability or employment,
including on the basis of disability
cerebral palsy, in the posts conditions of recruitment, with regard to all matters
identified
for
each hiring and employment, concerning all forms of
including
disability:
continuance of employment, employment,
conditions
of
recruitment,
Provided
that
the career advancement, and
appropriate
Government safe and healthy working hiring and employment,
continuance of employment,
may, having regard to the conditions;
career advancement, and
type of work carried on in
any
department
or (b) Protect the rights of safe and healthy working
establishment,
by persons with disabilities, on conditions;
notification subject to such an equal basis with others,
conditions, if any, as may be to just and favorable (b) Protect the rights of
specified
in
such conditions
of
work, persons with disabilities, on
notification, exempt any including
equal an equal basis with others, to
establishment from the opportunities and equal just and favorable conditions
provisions of this section.
remuneration for work of of work, including equal
equal value, safe and opportunities and equal
34. (1) The appropriate healthy working conditions, remuneration for work of
90
Government
may,
by including protection from equal value, safe and healthy
notification. Require that harassment,
and
the working
conditions,
from such date as May he redressing of grievances;
including protection from
specified. By notification.
harassment,
and
the
The employer in every © Ensure that persons with redressing of grievances;
establishment shall furnish disabilities are able to
such information or return exercise their labour and © Ensure that persons with
as may be prescribed in trade union rights on an disabilities are able to
relation
to
vacancies equal basis with others;
exercise their labour and
appointed for person, with
trade union rights on an
disability that have occurred (d) Enable persons with equal basis with others;
or are about to occur in that disabilities to have effective
establishment
to
such access to general technical (d) Enable persons with
Special
Employment and vocational guidance disabilities to have effective
Exchange as may be programmes,
placement access to general technical
prescribed
and
the services and vocational and and vocational guidance
establishment
shall continuing
training; programmes,
placement
thereupon comply with such
services and vocational and
requisition.
(e) Promote employment continuing
training;
(2) The form in which and opportunities and career
the intervals of time for advancement for persons (This article should be read
which information or returns with disabilities in the as folows)
shall be furnished and the labour market, as well as
particulars,
they
shall assistance
in
finding, 32.
Appropriate
contain shall be such as may obtaining and maintaining Governments shall—
be prescribed.
and
returning
to (a) Identify posts, and the
35. Any person authorized employment;
employment,
in
the
by the Special Employment
establishments, which can
Exchange in writing, shall (f) Promote opportunities be reserved for the persons
have access to any relevant for
self-employment, with disability in the public
record or document in the entrepreneurship,
the and private sectors both;
possession
of
any development
of (b) At periodical intervals
establishment, and may cooperatives and starting not exceeding three years,
enter at any reasonable time one’s own business;
review the list of posts
and premises where he
identified and up-date the
believes such record or (g) Employ persons with list taking into consideration
document to be, and inspect disabilities in the public the
developments
in
or take copies of relevant sector;
technology.
records or documents or ask
(Following
are
additional
any question necessary for (h) Promote the employment inclusion in 32 article from UN
obtaining any information.
of persons with disabilities Convention)
36.
Where
in
any in the private sector through
recruitment
year
any appropriate policies and (c) Promote opportunities
self-employment,
vacancy under section 33, measures,
which
may for
entrepreneurship,
the
cannot be filled up due to include affirmative action
development
of
cooperatives
non-availability of a suitable programmes, incentives and
and starting one’s own
verson with disability or, for other measures;
business;
any other sufficient reason,
(d) Promote employment
91
such vacancy shall be (i) Ensure that reasonable opportunities and career
carried forward in the accommodation is provided advancement for persons
succeeding recruitment year to persons with disabilities with disabilities in the
and if ;r the succeeding in
the
workplace; labour market, as well as
recruitment
year
also
assistance
in
finding,
suitable
person
with (j) Promote the acquisition obtaining and maintaining
disability is not available, it by persons with disabilities and
returning
to
may first be filled by of work experience in the employment;
interchange among the three open labour market;
(e) Promote opportunities
categories and only when
for
self-employment,
there is no parson with (k) Promote vocational and entrepreneurship,
the
disability available for the professional rehabilitation, development of cooperatives
post in that Year, the job retention and return-to- and starting one’s own
employer shall fill up the work
programmes
for business;
vacancy by appointment of persons with disabilities.
(f) Employ persons with
a person, other than a person
disabilities in the public
with disability:
2. States Parties shall ensure sector;
Provided that if the nature of that persons with disabilities (g) Promote the employment
vacancies
in
an are not held in slavery or in of persons with disabilities
establishment is such that a servitude, and are protected, in the private sector through
given category of person on an equal basis with appropriate policies and
can not be employed, the others, from forced or measures,
which
may
vacancies
may
be compulsory labour.
include affirmative action
interchanged among the
programmes, incentives and
three categories with the
other measures;
prior approval of the
appropriate Government.
38. (1) The appropriate
37. (1) Every employer shall
Governments and local
maintain such record in
authorities
shall
by
relation to the person. With
notification
formulate
disability employed in his
schemes
for
ensuring
establishment in such form
employment of persons with
and in such manner as may
disabilities,
and
such
be prescribed by the
schemes may provide for(Additional inclusion in 38 (1)
appropriate Government.
article)
(2) The records maintained
(g) Ensure that reasonable
under sub-section (1) shall
accommodation
is provided
be open to inspection at all
in
the
workplace;
and
reasonable hours by such
Promote vocational and
persons
as
may
be
professional
rehabilitation,
authorized in this behalf by
job retention and retum-togeneral or special order by
work
programmes
for
the appropriate Government.
persons
with
disabilities.
38. (1) The appropriate
Governments and local
authorities
shall
by
All
39.
governmental
notification
formulate
educational
institutions
and
for
schemes
ensuring
the local authorities and
92
employment of persons with
disabilities,
and
such
schemes may provide for(a) The training and welfare
of persons with disabilities;
(b) The relaxation of upper
age limit;
Regulating
employment;
©
the
other educational institutions
getting aid from the govt,
shell not only reserve, not
less then three present seats
for the PWDs, but also will
be responsible for full
participation with out any
discrimination and fully
enjoyment
of
the
employment as a right, by
their full participation and
barrier free environment.
(d) Health and safety
measures and creation of a
non-handicapping
environment in places where
persons with disabilities are
employed;
(e) The manner in which
and the person by whom the
cost of operating the
schemes is to be defrayed;
and
(f) Constituting the authority
for
the
responsible
the
administration
of
scheme.
Government
39.
All
educational institutions and
other
educational
institutions receiving aid
from the Government, shall
reserve not less than three
per cent seat for persons
with disabilities.
40.
The
appropriate
Governments and local
authorities shall reserve not
less than three per cent, in
all
poverty
alleviation
schemes for the benefit of
persons with disabilities.
41.
The
appropriate
Governments and the local
authorities shall, within the
limits of their economic
capacity and development,
provide
incentives
to
93
employers both in public
and private sectors to ensure
that at least five per cent of
their
work
force
is
composed of persons with
disabilities.
CHAPTER VII
AFFIRMATIVE
ACTION
ARTICLE 28 AFFIRMATIVE ACTION
ADEQUATE STANDARD
OF
LIVING
AND
SOCIAL PROTECTION
42-a- To provide aids and
42.
The
appropriate
governments
shall
by 1. States Parties recognize appliances and to create
notification make schemes to the right of persons with awareness about disability,
provide aids and appliances to disabilities to an adequate
and schemes and
persons with disabilities.
standard of living for programmes, and rights
43.
The
appropriate
themselves
and
their provided by the legislations,
Governments
and
local
authorities
shall
by families, including adequate among the general public,
notification frame schemes in food, clothing and housing
and especially among the
favor
of
persons
with
persons
and
to
the
continuous
Persons With Disabilities.
disabilities,
for
the
of living
preferential allotment of land improvement
at concession] rates forconditions and shall take b) Government will take all
(a) House;
appropriate
steps
to the necessary action and all
(b) Setting up business;
© Setting up of special safeguard and promote the the possible means like
realization of this right media both electronic and
recreation centers;
without
discrimination on Print, Radio or the means
(d) Establishment of special
the basis of disability.
available in the and has the
schools;
approach in the rural areas
(e)
Establishment
of
2. States Parties recognize and through public
research centers;
the
right of persons with institutions & networks like
(f)
Establishment
of
to
social Panchayat, youth group,
factories by entrepreneurs disabilities
protection,
and
to
the yuva kendra, Nav yuvak
with disabilitiesriate Go
enjoyment of that right Mandals, and various
without discrimination on committees, nari samuha,
the basis of disability, and Self Help groups,
shall take appropriate steps Anganwadies, ANMs, and
to safeguard and promote other govt. Bodies, for
the realization of this right, accessing and these
including measures:
schemes.
(a) To ensure equal access
by persons with disabilities
to clean water services, and
to
ensure
access
to
appropriate and affordable
services, devices and other
assistance for disability
related needs;
Artcle 28 - State parties and
local authorities, will ensure
?y the notification to equal
access to appropriate and
affordable primary health
care, and Public health
services, devices, (Aids and
appliances) and other health
94
(b) To ensure access by
persons with disabilities, in
particular women and girls
with disabilities and the
aged with disabilities, to
social
protection
programmes and poverty
reduction programmes;
care according to the needs,
especially for the women,
girls, and old age persons
with disabilities, like-clean
and safe drinking water,
proper immunization, Mid
day meal availability and
accessibility to the
maximum number of
children with disabilities,
free or subsidies Power
Supply, sanitation, Public
Housing, Rehabilitation and
prevocational training
centers etc.
(c) To ensure access by
persons with disabilities and
their families living in
situations of poverty to
assistance from the State
disability-related
with
(including
expenses
training, 28-2-c- equal access by
adequate
financial PWDs to the retirement
counseling,
assistance and respite care); benefits and programmes,
and increment in the amount
(d) To ensure access by of old age pension scheme
persons with disabilities to then a non-disabled person.
public housing programmes;
(e) To ensure equal access
by persons with disabilities
to retirement benefits and
programs.
CHAPTER VIII
NON ARTICLE 5 - EQUALITY EQUALITY AND NON
AND
NON DISCRIMINATION AND
DISCRIMINATION
EQUAL
DISCRIMINATION
44. Establishments in the
RECOGNISATION
transport sector shall, within
BEFORE THE LAW.
the limits of their economic
capacity and development for 1. States Parties recognize
the benefit of persons with that all persons are equal Article 5—(this will be add in Act
disabilities,
take
special before and under the law article 44)
measures toand are entitled without any 1. State parties shell
(a) Adapt rail compartments,
buses. Vessels and aircrafts in discrimination to the equal recognize by the notification
such a way as to permit easy protection and equal benefit that all the persons with
access to such persons;
disabilities are equal before
of the law.
(b) Adapt toilets in rail
the law and are entitled with
compartments,
vessels, 2. States Parties shall out any discrimination to the
aircrafts and waiting rooms prohibit all discrimination equal protection and equal
in such a way as to permit on the basis of disability and benefits of the law - to full
the wheel chair users to use guarantee to persons with fill this purpose state parties
them conveniently._______
95
45.
The
appropriate disabilities
equal
and shellGovernments and the local
effective
legal
protection
a) Ensure
non
authorities shall, within the
discrimination in any
limits
of their
economic against discrimination on all
capacity and development. grounds.
Public place, Public
Provide forservices,
Public
(a) Installation of auditory
3.
In
order
to
promote
Buildings,
and
Public
signals at red lights in the
and
eliminate
public roads for the benefit of equality
facilities, Public policies,
persons
with
visually discrimination States Parties
Programmes,
and
handicap;
shall take all appropriate
systems,
on
the
basis
of
(b) Causing curb cuts and
steps
to
ensure
that
any
kind
of
disability
or
slopes
to
be
made
in
pavements
for the
easy reasonable accommodation
impairment. And will
access of wheel chair users;
is provided.
ensure by notification the
© Engraving on the surface of
accessibility availability,
the zebra crossing for the
4.
Specific
measures,
which
affordability,
and
blind or for persons with low
are necessary to accelerate
vision;
comfort, for the persons
(d) Engraving on the edges of or achieve de facto equality
with disabilities.
railway platforms for the blind
of persons with disabilities, b) Not any delay and any
or for persons with low vision;
kind of discrimination in
(e)
Devising
appropriate shall not be considered
symbols of disability;
discrimination under the
the
public
and
(f)
Warning
signals
at terms
of the present
government funded or
appropriate places.
Convention.
supported services and
46.
The
appropriate
schemes will be accepted
Governments and the local
authorities shall, within the ARTICLE 12 - EQUAL
and consider by the state
limits
of their
economic
and local authorities.
capacity and development,
RECOGNITION
BEFORE
c)
If any discrimination and
provide fornegative
attitudinal
(a) Ramps in public buildings;
(b)
Braille
symbols
and THE LAW
behavior and delay will
auditory signals in elevators
be prove against the any
or lifts;
public
servant
or
©
Braille
symbols
and
department,
any
auditory signals in elevators 1. States Parties reaffirm
or lifts;
responsible authorities, or
(d)
Ramps
in
hospitals, that persons with disabilities
against a common man,
primary health centers and have the right to recognition
then
the appropriate govt,
other
medical
care
and everywhere
as persons
will take appropriate
rehabilitation institutions.
before the law.
47. (1) 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
against person and the
respective authorities.
2. States Parties shall
d)
To
ensure
the
recognize that persons with
discrimination
in
each
disabilities enjoy
legal
and
every
public
sector
capacity' on an equal basis
and services like - health
with others in all aspects of
education
insurance
life.
agriculture employment
and social justice, Law,
3. States Parties shall take
Human rights, and in the
appropriate measures to
fundamental
freedom,
provide access by persons
and their enjoyment, will
with disabilities to the
not be consider at any
support they may require in
cost
with the person with
exercising
their
legal
96
suitable post is available or he
attains
the
age
of
superannuation, whichever is
earlier.
capacity.
4. States Parties shall ensure
disabilities, and the state
parties
will
take
appropriate
legislative
that all measures that relate
action action against the
(2) No promotion shall be
responsible persons and
denied to a person merely on to the exercise of legal
law.
the ground of his disability:
2.
State
parties shell reaffirm
Provided that the appropriate
capacity
provide
for
that PWDs has the right to
Government
may,
having
regard to the type of work
recognition as person before
carried
on
in
any appropriate and effective
the Law and govt, will give
establishment, by notification
necessary support desired by
and
subject
to
such
conditions, if any, as may be safeguards to prevent abuse the PWDs for the full and
specified in such notification,
equal
participation,
exempt any establishment in accordance with
enjoyment, and exercise for
from the provisions of this
the
Human Rights through
section.
international human rights
the Law.
3.
State parties shell take
law. Such safeguards shall
appropriate
and effective
measure to ensure that the
ensure that measures
equal rights of persons with
disabilities to own and inherit
relating to the exercise of
property, to control their
financial affairs, and to have
legal capacity respect the
equal access and barrier free
environment to get the bank
rights, will and preferences loans, mortgages and other
forms of financial credit, and
of the person, are free of
shall ensure that persons with
disabilities are not arbitrarily
conflict of interest and
deprived of their property.
undue influence, are
4. State parties will take
proportional and tailored to effective
legislative and
judicial or others measures to
the person’s circumstances, prevent the rights of persona
with disabilities, on an equal
apply for the shortest time
basis and protection from
non exploitation and violence
possible and are subject to
illegal
human
behavior
including their gender based
regular review by a
aspect, and will provide
necessary
financial
and
competent, independent and legislative, moral mental, and
other required supports in
impartial authority or
this regards.
(article 16 (4-5))
a) States Parties shall put in
)lace effective legislation
97
judicial body. The
and
policies,
including
women and child focusec
safeguards shall be
legislation and policies to
promote
the
physical,
proportional to the degree to cognitive and psychological
recovery, rehabilitation and
which such measures affect social reintegration in the
society of persons with
the person’s rights and
disabilities, who become
victims of any form of
interests.
exploitation, violence or
abuse, including through the
provision
of protection
5. Subject to the provisions services.
Such
recovery
of this article States Parties b)
rehabilitation
and
shall take all appropriate and
effective measures to ensure re’nteSra^on shall take place
the equal right of persons in an environment that
with disabilities to own or fosters the health, welfare,
inherit property, to control self-respect, dignity and
their own financial affairs autonomy of the person and
and to have equal access to takes into account gender and
bank loans, mortgages and age specific needs.
other forms of financial
credit, and shall ensure that c) Ensure by notification the
persons with disabilities are provision of identification,
and
not arbitrarily deprived of investigation,
prosecution
the
cases
of
their property.
PWDs who became the
victims,
of
violence,
exploitation
harassment
(mental sexual and physical)
and abuse.
ARTICLE
16
FREEDOM
FROM
d) States Parties shall ensure
EXPLOITATION,
that,
gender and age
VIOLENCE AND ABUSE
sensitive assistance and
1. States Parties shall take support for persons with
and
their
all appropriate legislative, disabilities
amilies
and
caregivers,
administrative,
social,
through
the
educational
and
other including
provision
of
information
or
measures to protect persons
awareness
and
education
on
with disabilities, both within
and outside the home, from how to avoid, recognize and
instances
of
all forms of exploitation, report
violence
and
abuse, exploitation, violence and
including their gender based abuse protection services are
age, gender and disability
98
aspects.
sensitive.
2. States Parties shall also e) Appropriate govt, will take
take
all
appropriate in to account necessary help
measures to prevent all or
give
and
provide
forms
of
exploitation, assistance to the Non
violence and abuse by governmental Organizations
ensuring,
inter
alias, working in the respective
appropriate forms of gender disabilities fields, to handle
and age sensitive assistance these cases and their desired
and support for persons with help and assistance.
disabilities
and
their
families and caregivers,
including
through
the
provision of information and
education on how to avoid,
recognize
and
report
instances of exploitation,
violence and abuse. States
Parties shall ensure that
protection services are age,
gender
and
disability
sensitive.
3. In order to prevent the
occurrence of all forms of
exploitation, violence and
abuse, States Parties shall
ensure that independent
authorities
effectively
monitor all facilities and
programmes designed to
serve
persons
with
disabilities.
4. States Parties shall take
all appropriate measures to
promote
the
physical,
cognitive and psychological
recovery, rehabilitation and
social
reintegration
of
persons with disabilities
who become victims of any
form
of
exploitation,
violence or abuse, including
through the provision of
protection services. Such
recovery and reintegration
99
shall take place in an
environment that fosters the
health, welfare, self-respect,
dignity and autonomy of the
person and takes into
account gender and age
specific needs.
5. States Parties shall put in
place effective legislation
and policies,
including
women and child focused
legislation and policies, to
ensure that instances of
exploitation, violence and
abuse against persons with
disabilities are identified,
investigated and, where
appropriate, prosecuted.
CHAPTER
RESEARCH
MANPOWER
DEVELOPMENT
IX ARTICLE
31
RESEARCH
AND STATISTICS
AND MANPOWER
DATA COLLECTION
DEVELOPMENT
The
appropriate
Governments
and
local
authorities shall promote and
sponsor research, inter alia,,
in the following areas48.
(a) Prevention of disability;
(b) Rehabilitation including
community
based
rehabilitation;
© Development of assistive
devices
including
their
psychosocial aspects;
(d) Job identification;
(e) On site modifications in
offices and factories.
49.
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
AND
(Followings article should be include in the
pwd Act in this Chapter)
1. States Parties undertake
to
collect
appropriate
information,
including
statistical and research
data, to enable them to
formulate and implement
policies to give effect to
the present Convention.
The process of collecting
and
maintaining
this
information shall:
(a) Comply with legally
established
safeguards,
including legislation on
data protection, to ensure
confidentiality and respect
for the privacy of persons
with disabilities;
States Parties undertake to
collect
appropriate
information, and sponsor
research in the field of
disabilities,
like
prevention, new causes due
to developmental changes in
the society or others causes,
new issues faces by the
PWDs in the in the sense of
their social integration and
inclusion in the society,
causes, and prevention, and
others
rights
based
approaches, and the methods
of
their
maximum
participation in the society,
and the capacity building
through the education and
other training programmes.
(b)
Comply
with
internationally
accepted
norms to protect human
100
research
for
special rights and fundamental
education, rehabilitation and freedoms
and
ethical
manpower development.
principles of statistics.
2.
The
information
collected in accordance
with this article shall be
disaggregated
as
appropriate and used to
help
assess
the
implementation of States
Parties obligations under
the present Convention,
and to identify and address
the barriers faced by
persons with disabilities in
exercising their rights.
3. States Parties shall
assume the responsibility
for the dissemination of
these statistics and ensure
their
accessibility
to
persons with disabilities
and others.
UN convention of Eighth ad hock Suggestions to add In the Persons
committee
___________ With Disabilities
ARTICLE 25 - HEALTH
States Parties recognize that persons with
disabilities have the right to the enjoyment
of the highest attainable standard of health
without discrimination on the basis of
disability. States Parties shall take all
appropriate measures to ensure access for
persons with disabilities to health services
that are gender sensitive, including healthrelated rehabilitation. In particular, States
Parties shall:
(a) Provide persons with disabilities with
Health is a basic Human right, and it
should be born in the mind that health is
state of well being of all the section of
human life. Like social. Economical,
political, cultural, political, spiritual
mental, behavioral and communal, and
not merely the absence of diseases.
To save this Human right various has been
made at the govt, and private level.
(article 25 should be include in the peoples
with disability Act. 1995, with the following
101
the same range, quality and standard of free
or affordable health care and programmes
as provided other persons, including in the
area of sexual and reproductive health and
population-based
public
health
programmes;
(b) Provide those health services needed by
persons with disabilities specifically
because of their disabilities, including early
identification
and
intervention
as
appropriate, and services designed to
minimize and prevent further disabilities,
including among children and the elderly;
(c) Provide these health services as close as
possible to people’s own communities,
including in rural areas;
(d) Require health professionals to provide
care of the same quality to persons with
disabilities as to others, including on the
basis of free and informed consent by, inter
alia, raising awareness of the human rights,
dignity, autonomy and needs of persons
with disabilities through training and the
promulgation of ethical standards for public
and private health care;
(e) Prohibit discrimination against persons
with disabilities in the provision of health
insurance, and life insurance where such
insurance is permitted by national law,
which shall be provided in a fair and
reasonable manner;
(f) Prevent discriminatory denial of health
care or health services or food and fluids on
the basis of disability.
suggestions)
1. State parties shell recognized that persons
with disabilities has the right to the
enjoyment of highest attainable standard of
the health with out and discrimination and
equal basis.
2. State parties shell take appropriate
measures to ensure the access of health and
health care services, that are gander
sensitive including health related
rehabilitation for the Persons With
Disabilities.
To fulfill these objectives state parties shell
Provide same range of quality of
services and standard of health on free
or nominal cost, with accessible and
affordable health care services and
programme provided by other persons
and organizations, including the area of
sexual and reproductive health, need
and priority based public health services
or programme.
h) Take into account by the notification
to the millennium Development goals,
especially poverty elevation
programme, which is the biggest root
cause of the disability. The provision to
the promotion of local health traditions
and the training of persons with
disability, regarding these traditions
Provide these health care services as
i)
close as possible to the persons with
disabilities and community.
Responsibilities and accountability of
the gram Panchayat and village health
committees of the Gram Panchayat to
ensure the monitoring of the health
services and need based programme.
And the promotion and strengthen to
the concept of the community health,
through the community building, and
through the Community Based
Rehabilitation.
j) Ensure or will make provision for the
community participation of the each
public and community health
g)
102
programme to ensure the full and equal
participation of the Persons With
Disability, with their full potential and
creativity in Decision making Planning,
Implementation, and the Monitoring of
the programme.
k) Ensure the prioritization and
recognition of their needs, and coalition
and gathering for the demanding of
their needs through legal action by
participating in the decentralized system
and using the power of democracy.
l) Ensure that the primary health services
should be more rural based and the
primary health care system or the
services are accessible and affordable to
Persons with Disability and the
accessibilities of these services in the
remote out reach rural areas to serve
maximum number of PWDs
Appropriate govt, should take all the
necessary actions and to prevent from the
causes of the disability in the rural areas and
trained more and more community workers
to build the capacity and self - confidence
of persons with disabilities
ARTICLE 25 - HEALTH
Health is a basic Human right, and it should be bom in the mind that health is
state of well being of all the section of human life. Like social, Economical,
political, cultural, political, spiritual mental, behavioral and communal, and
not merely the absence of diseases.
To save this Human right various has been made at the govt, and private
level.
(article 25 should be include in the peoples with disability Act. 1995, with the
following suggestions)
1. State parties shell recognized that persons with disabilities has the right to
the enjoyment of highest attainable standard of the health with out and
discrimination and equal basis.
2. State parties shell take appropriate measures to ensure the access of health
and health care services, that are gander sensitive including health related
rehabilitation for the Persons With Disabilities.
To fulfill these objectives state parties’ shell 103
f) Provide same range of quality of services and standard of health on free
or nominal cost, with accessible and affordable health care services and
programme provided by other persons and organizations, including the
area of sexual and reproductive health, need and priority based public
health services or programme.
g) Take into account by the notification to the millennium Development
goals, especially poverty elevation programme, which is the biggest
root cause of the disability. The provision to the promotion of local
health traditions and the training of persons with disability, regarding
these traditions
h) Provide these health care services as close as possible to the persons
with disabilities and community. Responsibilities and accountability of
the gram Panchayat and village health committees of the Gram
Panchayat to ensure the monitoring of the health services and need
based programme. And the promotion and strengthen to the concept of
the community health, through the community building, and through
the Community Based Rehabilitation.
i) Ensure or will make provision for the community participation of the
each public and community health programme to ensure the full and
equal participation of the Persons With Disability, with their full
potential and creativity in Decision making Planning, Implementation,
and the Monitoring of the programme.
j) Ensure the prioritization and recognition of their needs, and coalition
and gathering for the demanding of their needs through legal action by
participating in the decentralized system and using the power of
democracy.
k) Ensure that the primary health services should be more rural based and
the primary health care system or the services are accessible and
affordable to Persons with Disability and the accessibilities of these
services in the remote out reach rural areas to serve maximum number
of PWDs
l) Appropriate govt, should take all the necessary actions and to prevent
from the causes of the disability in the rural areas and trained more and
more community workers to build the capacity and self - confidence
of persons with disabilities
States Parties recognize that persons with disabilities have the right to the
enjoyment of the highest attainable standard of health without discrimination
on the basis of disability. States Parties shall take all appropriate measures to
ensure access for persons with disabilities to health services that are gender
104
sensitive, including health-related rehabilitation. In particular, States Parties
shall:
(a) Provide persons with disabilities with the same range, quality and standard
of free or affordable health care and programmes as provided other persons,
including in the area of sexual and reproductive health and population-based
public
health
programmes;
(b) Provide those health services needed by persons with disabilities
specifically because of their disabilities, including early identification and
intervention as appropriate, and services designed to minimize and prevent
further disabilities, including among children and the elderly;
(c) Provide these health services as close as possible to people’s own
communities, including in rural areas;
(d) Require health professionals to provide care of the same quality to persons
with disabilities as to others, including on the basis of free and informed
consent by, inter alia, raising awareness of the human rights, dignity,
autonomy and needs of persons with disabilities through training and the
promulgation of ethical standards for public and private health care;
(e) Prohibit discrimination against persons with disabilities in the provision of
health insurance, and life insurance where such insurance is permitted by
national law, which shall be provided in a fair and reasonable manner;
(f)
Prevent discriminatory denial of health care or health services or food
and fluids on the basis of disability.
ARTICLE 21 - FREEDOM OF EXPRESSION AND OPINION, AND
ACCESS TO INFORMATION
I
States Parties shall take all appropriate measures to ensure that persons with
disabilities can exercise their right to freedom of expression and opinion,
including the freedom to seek, receive and impart information and ideas on an
equal basis with others and through sign languages, Braille, augmentative and
alternative communication, and all other accessible means, modes and
formats of communication of their choice, including by:
(a)
Providing information intended for the general public to persons with
disabilities in accessible formats and technologies appropriate to different
kinds of disabilities in a timely manner and without additional cost;
(b) Accepting and facilitating the use of sign languages, Braille,
augmentative and alternative communication, and all other accessible means,
modes and formats of communication of their choice by persons with
disabilities in official interactions;
105
(c)
Urging private entities that provide services to the general public,
including through the Internet, to provide information and services in
accessible and usable formats for persons with disabilities;
(d) Encouraging the mass media, including providers of information through
the Internet, to make their services accessible to persons with disabilities;
(e)
Recognizing and promoting the use of sign language.
ARTICLE 13 - ACCESS TO JUSTICE
1.
States Parties shall ensure effective access to justice for persons with
disabilities on an equal basis with others, including through the provision of
procedural and age appropriate accommodations, in order to facilitate their
effective role as direct and indirect participants, including as witnesses, in all
legal proceedings, including at investigative and other preliminary stages.
2.
In order to help ensure effective access to justice for persons with
disabilities, States Parties shall promote appropriate training for those
working in the field of administration of justice, including police and prison
staff.
ARTICLE 9 - ACCESSIBILITY
1.
To enable persons with disabilities to live independently and
participate fully in all aspects of life, States Parties shall take appropriate
measures to ensure to persons with disabilities access, on an equal basis with
others, to the physical environment, to transportation, to information and
communications, including information and communications technologies
and systems, and to other facilities and services open or provided to the
public, both in urban and in rural areas. These measures, which shall include
the identification and elimination of obstacles and barriers to accessibility,
shall apply to, inter alia:
(a) Buildings, roads, transportation and other indoor and outdoor facilities,
including schools, housing, medical facilities and workplaces;
(b) Information, communications and other services, including electronic
services and emergency services.
2.
States Parties shall also take appropriate measures to:
106
(a)
Develop, promulgate and monitor the implementation of minimum
standards and guidelines for the accessibility of facilities and services open or
provided to the public;
(b) Ensure that private entities that offer facilities and services which are
open or provided to the public take into account all aspects of accessibility for
persons with disabilities;
(c)
Provide training for stakeholders on accessibility issues facing persons
with disabilities;
(d) Provide in buildings and other facilities open to the public signage in
Braille and in easy to read and understand forms;
(e)
Provide forms of live assistance and intermediaries, including guides,
readers and professional sign language interpreters, to facilitate accessibility
to buildings and other facilities open to the public;
(f)
Promote other appropriate forms of assistance and support to persons
with disabilities to ensure their access to information;
(g) Promote access for persons with disabilities to new information and
communication technologies and systems, including the Internet;
(h) Promote the design, development, production and distribution of
accessible information and communications technologies and systems at an
early stage, so that these technologies and systems become accessible at
minimum cost.
CHAPTER FOUR
4.7 Learning's Suggestions for CBR
4.7.1
Learning’s:
My major learning during the entire period was the concept of rehabilitation,
and the concept of the disability. Problems are everywhere, it arises in the
society or in the community, so for the solution of the problems should be in
the society. We can’t solve the problem of the persons with disabilities to
segregate them from the community. To solve the problem of PWDs we have
107
to change the attitude of the community toward them and integrate them in
the community.
I
Concept of the Community Based Rehabilitation, determinants of
disability and the situation of the persons with disabilities in India.
II
Nature of the organization (CBR Forum, Sanchar, COD, APD).
III.
Concept of the Advocacy, its importance, especially in the field of
Community Based Rehabilitation.
IV.
Role of the CBR Forum in the promotion of the concept of CBR
through the planning, monitoring, evaluation, and assistance
through funding.
V.
Capacity building of the PWDs through the different activities. Like
income generation, and key leaders trainings, etc.
VI.
Understanding about the Persons With Disability Act 1995, and UN
Draft convention of 8th Ad Hoc Committee on the protection and
rights of persons with disabilities
VII.
It helped me it understand the need of person with disabilities. What
we can do to fulfill their basic requirements , and how maximum we
can utilize available resources toward it.
VIII. Individual and social rehabilitation plan to build the capacity of
persons with disability at individual and social level to ensure their
maximum participation and involvement in the community or social
activities.
4.7.2
Suggestions;
Following are some of my suggestions what I experienced during the field
visits and through the reading of various articles, and books in this period.
108
I
CBR is the concept of the community participation but most of the
places I felt that it is not being implemented. So the organization should
ensure to the proper implementation and community participation in the
project.
II.
The integration of the CBR in the various other programmes of the
organization should be must.
III.
Organizations should be more emphasize to the trainings of the field
workers. Especially the training of public relation and management.
IV.
The aim of SHGs formation not only to promote small savings, but
also it should be seen as a platform which gathers peoples to
demand their rights, and the participation in the mainstreaming
society. It could be the best tool of advocacy.
V.
The migration from one to another job, of the CBR workers has
seen as a problem and lacuna in the CBR programme, so the
organization should ensure two things, first to increase the
incentives of the CBR workers, and second one is the maximum
involvement of the community members to ensure the success and
take over the programme in the future.
VI.
The awareness in the community regarding the problems of persons
with disabilities, disability, its prevention, attitudinal, and
behavioral change should be must.
VII. The employment of the persons with disabilities in the CBR
programme could give them a great sense of ownership, and they
can contribute with new creative ideas for the success of CBR
programme.
109
VIII. CBR forum should promote the organizations to conduct research at
the local level to get more concrete information regarding real
conditions of persons with disabilities.
IX.
CBR Forum should promote to the partner organizations to conduct
the research, regarding status or real situation, about the
implementation of PWD Act 1995. this data should be compile at
the secretariat level for the assistance of advocacy and campaigning.
4.7.3
Conclusion
India is a developing country. It has a democratic governance system. The
means of governance is to government of the people, to the people, and by
the people. The aim of this system is to make empower to the every citizen of
the country. And the power should be in the hand of the local citizens. This
concept introduced the concept the decentralized Panchayat or local self-
governance system. All these things show that the aim of every activity is to
ensure the participation of the local community.
CBR is one of the kinds of democratic process; it is a developmental concept
and work for the betterment of the community. It is empowering the people
through the training, education, awareness, and involvement in the income
generation activities. CBR shows that every person is the part of the
community. Community is just like a body, and community members are
parts of the body. If any part of body does not work well or properly or have
any problem then whole body suffers. If one hand has injuries, then other
hand comes for their help. Other part of the body doesn’t discriminate, or
injured hand doesn’t feel the discrimination from the other parts, they come
together, live together and proper coordination uphold the dignity of the
body.
no
Same as the Community Based Rehabilitation want to develop the concept
and feelings in the society and community, that the persons with disability are
the part of the body they should not feel or face any discrimination in the
community and especially in their families, and they should be included with
their full capacity and creativity, this concept empower to the PWDs in their
communities and families
It can be seen that the PWDs and their families are a great asset of any CBR
programme. They really know the environmental condition around them and
understand the effects of their life. They have batter knowledge that what is
the meaning of the disability, and how stigma is affecting their life, socially,
economically, politically culturally, and spiritually.
In the end of the conclusion I would like to say that the analysis of the
community structure is important with in which CBR is embedded. The
existence of the power structure ; the difference between PWDs and non
disabled man and women, disabled man and women, are glaring realities. The
recognition of these differences is crucial for the CBR as for many
community-oriented programmes
The data of census 2001 says persons with disability consist 2% population of
India, and out of this two percent population, hardly 2% children with
disabilities are receiving any kind of education and rehabilitation services.
Most of the rehabilitation and institutional services are urban based and quite
expensive, that a common man can’t afford.
In this condition CBR Forum shifted their paradigm from urban to rural and
takes into account to promote the concept of Community Based
Rehabilitation in the rural areas, rather then institutional based rehabilitation,
and serving to the poor & most marginalized society of the community in the
rural areas. With its more then 85 partners organizations allover India. The
implementations of CBR programme through the partner organizations in the
field want to develop or create a barrier free environment and an atmosphere
where the persons with disabilities should be accepted with their abilities,
seen without any discrimination in society, and contribute in the development
of community with their full potential and skills.
Ill
JAN SWASTHYA SAHYOG
ganiYari, bilaspur
CHHATISGARH.
> Learning objectives
> Health workers training
> Scabies survey
Introduction of the study
Village information
Why study done
Information about scabies
Findings
________________
Sf
jig
PlacementJAN SWASTHYA SAHYOG (JSS),
Ganiyari, Bilaspur, Chhattisgarh.
Learning objectives:Following are my learning objectives for the second field placemetn in JSS.
0
To know about the organization (JAN SWASTHYA SAHYOG).
To do a community based survey on the prevalence of the scabies.
0
Involvement in the Selection process of community health workers.
0
Training of community health workers.
0
In the way to fulfill the learning objectives, and due to short placement of
a month, I was not able to work on some of the following objectives;
O
0
Planning and monitoring of different health programmes.
To understand the involvement of JSS in the NRHM process.
But I came to know more about
O
The appropriate technology for health.
Programme of the Jan Swasthya Sahyog.
My schedule during working days were as follows ;
A)
b)
c)
d)
On 28 of November 2006 I attended a meeting at JSS with the
HIV/AIDS patient. The Chattisgarh Aids control Society wanted to
start a programme with HIV positive people, with this initiative a
group is formed of HIV+ people called Chattisgarh Network for
Positive People.
From 05/12/06 to 08/12/06
- 1 did a pilot survey in the field are of
JSS, to know the condition of scabies disease.
From 09/12/06 to 14/12/06
- I did asurvey on the scabies in two
villages called Damanpur and Bandipara of Kota block.
From 15/12/06 to 16/12/06
I attended health workers
training in Shivtarai Village. This training programe was attended by
the 13 new village health workers, who were selected by the JSS. In
this training programme specially training given on the two issues or
problem seen as a prevalence in the villages. First training on malaria
and second on scabies. In the third Day the programme of slide
112
preparation or taking of blood smears was the most interesting work
done by the health workers.
New health worker training
Shivtrai village. (15 to 17 December 2006).
To spread the work in the new villages after a long process JSS started a
training programme for the new selected health worker in a programme
village Shivtarai.
13 female health workers, out of total 17 village health workers from
different villages attended this programme for two days. The process of the
selection of the health workers was on the voluntary basis. Selection process
done with the consent of gram sabha and family members of the selected
person. Village team of JSS asked the name of either one or two health
workers and then they got these few voluntary activists. Most of them are
either illiterate of had left their education up to second standard.
Most of the health workers had came there with their children, they were on
their respected cast in the village. This was probably the first time in their life
where they are out of their village alone, and committed to the health. This
training programme had an informal way to interact with each other. In this
training the challenge before the trainer to was to motivate them for the
discussion, to eradicate the hesitation, they were feeling and to provide and
free environment to create their understanding regarding health and sanitation
and make them understand about the health conditions and the realities.
Primary objectives of the training were to train them for the recognition of the
common disease have prevalence around them; like Malaria, fever,
pneumonia, and main objective was to train them to preparer thick blood
smears at village level. These thick smears are helpful to at least diagnosis of
malaria. These blood smears slides comes to the village center Ganiyari by
public transport system, an innovative mechanism developed by the JSS for
the early diagnosis of malaria.
My learning’s
to attend and look after a health workers programme was
involved in my learning objectives, and this is one of my interested area in
health. But it is not easy that I had been feeling earlier. Through this training
programe I have following learnings :
113
During the training I felt that now a days these health workers are
the only hope to provide good and quality services to the un reached
or out reached area where to get the public health services still is a
like a dream.
Selection of the health worker is a quite lengthy time consuming
and hectic process. It is not easy to find out or make agree voluntary
and women health worker. Due to gender sensitivity, and traditional
culture, customs and beliefs, it is quite for the women to break them
and come from the village for the social benefits.
Due to culture or local beliefs and family structure girls drop out
rate is higher in the tribal area, so it is too difficult to find out at
least primary level educated women for the programme.
Due to shy nature of women they often feel hesitation and don’t talk
frequently, this is the main problem during training to provide them
free environment and motivate them to speak frequently. To solve
this problem the trainer or facilitator has to have and know about
them complete information, facilitation of the facilitator is a skill to
make effective to the training.
Command over the issue and information about the local belief
culture, customs and traditions is also an important factor for the
success of the training
Appropriate technology
Technology is and essential component of health care at all levels, which
works for the detection, diagnosis, treatment, prevention, availability,
accessibility, and maximum utilization in the positive sense. There for the
availability of appropriate health related technologies in the field of health
care is an essential tool in providing health care in the rural or out reach areas.
Technologies have developed rapidly in field of health care, in the last several
years, and peoples are getting benefited continuously as a life saving form.
Now the several severe diseases when doctors were not able to even
diagnosis, now being treated successfully. Some times it is looks like a boon
given by the god, to save life. But these life saving technologies are only
available to a particular section, not for every one, due to high cost in the
urban areas, which is not possible to use by the poor.
114
However the availability of the health related technologies at the primary
health care level in the rural are extremely limited. In the case of many
diseases and conditions of public health system
To meet the requirements or health needs in the rural areas of JSS is working
and serving with the appropriate technology, and this process is still continue:
Following are the man concern developed as appropriate technology;
0
0
O
0
0
0
0
0
O
0
0
Measurement of anemia using copersulfate
Diagnosis of sickle cell anemia
Breath counter
Measurement of hight
Reproductive health kit
Easy to read thermometer.
Ors
Tablet breaker
Safe delivery kit
First aid kit
Water disinfection system.
Scabies prevalence study
Objective of the survey
Following are the main objectives of my study on scabies.
1
2
3
4
5
6
7
8
To see the prevalence of scabies in the rural areas.
To see the economical conditions in the rural area.
To see the indebtedness in the rural areas, due to scabies and other
illness.
To look at the socio-economical conditions in the rural area.
To know the awareness level the scabies in the rural areas.
To know perception regarding scabies.
To see the health conditions in the rural areas.
To see the family status of the families in the village.
115
Back ground of the Villages
Universe of the study
In the social research, society is the laboratory, for the social researchers. In
my study I did my survey in the two villages of Bilaspur districts Kota and
Lormi block one village each.
Following is the information for these two villages:1
Davanpur
this is the village comes under the KOTA block, of
Bilaspur district. 56 km away from Bilaspur, and 26 km from the KOTA
block, no bus facility available or public transport available to reach this
village. Peoples use two sides to reach this village one from kota and second
from Shivtarai, but peoples have to cross small rivers from both sides to reach
the village, and often in the rainy season these small rivers got over flooded,
which cause to cut all the connections from the others. Most of the population
is depend on the agriculture work and something they suppose to get from the
forest. Most of the people work for the livelihood in others fields also it
means they can be called agricultural labors. Agriculture production in their
own field is not sufficient to fulfill their food requirements for the whole year.
They want or get rice as their wage. Crops dependents on the rain and they
don’t have means to do irrigation for their lands. Most of the land is has taken
over by them illegally, they called it “Beja kabja”.
2
Jakad bandha is more then 80 km away from the main district
bilaspur and 40 km away from LORMI block of Bilaspur district. This is the
highly forested area and Achahanakmar is the main village govt, of
CHATTISGARH has been declared a sanctuary to this pure tribal area. This
village is consisting here in three parts, URAO PARA, BAIGA PARA, and
last one is jakadbandha. Three tribes are living here, in ORAO PARA most of
the population is URAO tribals, and rest of the village is consists of GONDs
and URAOs. This tribal village has 96 pure kachcha but clean house hold.
Most of the peoples are land less labor, but for the livelihood they have
captured some land in their words it is called “Beja Kabja” and doing farming
activities which depends on the rain, like others tribals areas here also the
lack of basic services can be seen. Basic primary public health services are
disappeared. Peoples have to migrate for the search of the livelihood, to the
far most area, like Bilaspur, Delhi, Bombay, Hydrabad, Bhopal, Kolkata, etc.
116
in the absence of main persons of the family only women has to look after for
their families. Education services and even Aanganwadies are not working
and even being trained properly. One private mission school is here with
more then 50 student from different near and far villages. Rice is the only
crop being received by the village peoples, and up to some extent they use
some forest seasonable crop which contributes something for their
economical condition. Use of local home made liquor is very common in
these areas and also the part of culture.
Three lakes are around the village. But in the summer seasons only one lake
has the water to full fill the requirement of daily use of the village. To fulfill
the requirement of the drinking water of the village there are only four hand
pumps are serving to the whole village. Wells are also in the village but it is
rarely used by the villagers.
Why the study
In the recent years this had been felt that peoples of the rural area suffering
very much form the problem of scabies, and during the village intervention it
found that the prevalence is higher and peoples are complaining regarding the
problem of scabies. If the peoples have the personal hygiene and sanitation,
and if they are taking the regular bath, then the mite that is the cause of
scabies will disappear. But the condition in the rural areas is just different.
Peoples are spending un necessary money the treatment on the scabies. Jhola
chap Doctors are treating this problem through the saline bottle and injection
and charging 20 to 50 Rs. For the treatment, that could be cure in just Rs 5 to
6. this un necessary treatment becomes the cause of rural indebtedness. Most
of the time peoples goes to the local healers or tend to Jhad-phook due to
cultural beliefs and blind faith. That also pushes them to the indebtedness.
Most of the affected from the scabies are children and women, which
becomes ignore or separated in the community and even in the family and
doesn’t come to show them self if they are suffering from the problem.
Children are ignored due to lack of attention of the parents or lack of money,
they does their local treatment. Their one visit from the village to health
centre becomes cause of lose of their one days wage, and it becomes more
severe when irrational treatment done by the doctors.
In this Proforma following were the information to be collected.
Respondent, caste, class, gender, family, Family members, economical
condition, land food, prevalence of scabies, house hold information, and in
the last their perception about the problem.
117
Something about scabies
Scabies is caused by the mite Sarcoptes scabiei, variety hominis, as shown by
the Italian biologists Diacinto Cestoni in the 18th century. It produces intense,
itchy skin rashes when the impregnated female tunnels into the stratum
comeum of the skin and deposits eggs in the burrow. The larvae, which hatch
in 3-10 days, move about on the skin, molt into a "nymphal" stage, and then
mature into adult mites. The adult mites live 3-4 weeks in the host's skin.
The motion of the mite in and on the skin produces an intense itch which may
resemble an allergic reaction in appearance. The presence of the eggs
produces a massive allergic response which, in turn, produces more itching.
Scabies is transmitted readily, often throughout an entire household, by skinto-skin contact with an infected person (e.g. bed partners, schoolmates,
daycare), and thus is sometimes, although inaccurately, classed as a sexually
transmitted disease. Spread by clothing, bedding, or towels is a less
significant risk, though possible.
Onset
It takes approximately 4-6 weeks to develop symptoms after initial
infestation. Therefore, a person may have been contagious for at least a
month before being diagnosed. This means that person might have passed
scabies to anyone at that time with whom they had close contact. Someone
who sleeps in the same room with a person with scabies has a high possibility
of having scabies as well, although they may not show symptoms.
The symptoms are caused by an allergic reaction that the body develops over
time to the mites and their by-products under the skin, thus the 4-6 week
"incubation" period. There are usually relatively few mites on a normal,
healthy person—about 11 females in burrows. Scabies are microscopic
although sometimes they are visible as a pinpoint of white. The females
burrow into the skin and lay eggs there. Males roam on top of the skin,
however, they can and do occasionally burrow. Both males and females
surface at times, especially at night. They can be washed or scratched off
(however scratching should be done with a washcloth to avoid cutting the
skin as this can lead to infection), which, although not a cure, helps to keep
the total population low. Also, humans create antibodies to the scabies mites
which do kill some of them.
118
Signs, symptoms, and diagnosis
A scabies burrow can be seen under magnification. The scaly patch is due to
scratching of the original papule. The mite travels from there, where it can be
seen as a dark spot at the end of the burrow.
A delayed hypersensitivity (allergic) response resulting in a papular eruption
(red, elevated area on skin) often occurs 30-40 days after infestation. While
there may be hundreds of papules, fewer than 10 burrows are typically found.
The burrow appears as a fine, wavy and slightly scaly line a few millimeters
to one centimeter long. A tiny mite (0.3 to 0.4 mm) may sometimes be seen at
the end of the burrow. Most burrows occur in the webs of fingers, flexing
surfaces of the wrists, around elbows and armpits, the areolae of the breasts in
females and on genitals of males, along the belt line, and on the lower
buttocks. The face usually does not become involved in adults.
The rash may become secondarily infected; scratching the rash may break the
skin and make secondary infection more likely. In persons with severely
reduced immunity, such as those with HIV infection, or people being treated
with immunosuppressive drugs like steroids, a widespread rash with thick
scaling may result. This variety of scabies is called Norwegian scabies.
Scabies is frequently misdiagnosed as intense pruritus (itching of healthy
skin) before popular eruptions form. Upon initial pruritus the burrows appear
as small, barely noticeable bumps on the hands and may be slightly shiny and
dark in color rather than red. Initially the itching may not exactly correlate to
the location of these bumps. As the infestation progresses, these bumps
become more red in color.
Generally diagnosis is made by finding burrows, which often may be difficult
because they are scarce, because they are obscured by scratch marks, or by
secondary dermatitis (unrelated skin irritation). If burrows are not found in
the primary areas known to be affected, the entire skin surface of the body
should be examined.
The suspicious area can be rubbed with ink from a fountain pen or alternately
a topical tetracycline solution which will glow under a special light. The
surface is then wiped off with an alcohol pad; if the person is infected with
scabies, the characteristic zigzag or S pattern of the burrow across the skin
will appear.
When a suspected burrow is found, diagnosis may be confirmed by
microscopy of surface scrapings, which are placed on a slide in glycerol,
119
mineral oil or immersion in oil and covered with a coverslip. Avoiding
potassium hydroxide is necessary because it may dissolve fecal pellets.
Positive diagnosis is made when the mite, ova, or fecal pellets are found.
Causal Agent:
Sarcoptes scabei, human itch or mange mites, are in the arthropod class
Arachnida, subclass Acari, family Sarcoptidae. The mites burrow into the
skin but never below the stratum comeum. The burrows appear as raised
serpentine lines up to several centimeters long. Other races of scabies may
cause infestations in other mammals such as domestic cats, dogs, pigs, and
horses. It should be noted that races of mites found on other animals may
establish infestations in humans. They may cause temporary itching due to
dermatitis but they do not multiply on the human host.
Life Cycle:
O
0
e
0
EggShateh
reteaskig larvae/
Lava* mox
into nymphs
Larvae and
t. nymphs are
found in
short burrows
called molting
pouches.
$
0
aK"
E09
Mutt female*
depose c$gs
>s they burrov.
.5^^ their moMinQ pourhiT*
The primary mode of transmission is persorvto-person
_ Occastonalfy transmission may occur via fomftes.
o
M.
Mi
AA
Mites are found predommartiy
between fingers a nd on the wrists
(areas highsgreed in
Highiighred areas in pMK
represent the most common sites
where rashes may occur, although
they can occur elsewhere
A »Intectt/e Stage
/^= Diagnostic Stage
„r-’ ■
t
Mating occurs after
the mate penetrates
the moving pouch
of the aduSfemale
Sarcoptes scabei
four
undergoes
stages in its life
cycle; egg, larva,
nymph and adult.
Females
deposit
eggs at 2 to 3 day
intervals as they
burrow through the
skin O. Eggs are
oval and 0.1 to
0.15 mm in length
©and incubation
time is 3 to 8
days. After the
eggs hatch, the
larvae migrate to
the skin surface
and burrow into
the intact stratum
to
comeum
almost
construct
short
invisible,
called
burrows
molting pouches.
The larval stage,
120
which emerges from the eggs, has only 3 pairs of legs ©, and this form lasts 2
to 3 days. After larvae molt, the resulting nymphs have 4 pairs of legs O.
This form molts into slightly larger nymphs before molting into adults.
Larvae and nymphs may often be found in molting pouches or in hair follicles
and look similar to adults, only smaller. Adults are round, sac-like eyeless
mites. Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide, and males
are slightly more than half that size. Mating occurs after the nomadic male
penetrates the molting pouch of the adult female 0. Impregnated females
extend their molting pouches into the characteristic serpentine burrows,
laying eggs in the process. The impregnated females burrow into the skin and
spend the remaining 2 months of their lives in tunnels under the surface of the
skin. Males are rarely seen. They make a temporary gallery in the skin
before
mating.
Transmission occurs by the transfer of ovigerous females during personal
contact. Mode of transmission is primarily person to person contact, but
transmission may also occur via fomites (e.g., bedding or clothing). Mites are
found predominantly between the fingers and on the wrists. The mites hold
onto the skin using suckers attached to the two most anterior pairs of legs.
Geographic Distribution:
Scabies mites are distributed worldwide, affecting all races and
socioeconomic classes in all climates.
study of books and others
These were the main reasons to conduct the study of rural area to know the
perception and to know the socio-economical, which is being affected by the
disease. In this study we also tried to see the social causes and the prevalence
of scabies in the rural area. In this process I started my study with the
following steps
In the process of starting my study I first here study about the scabies, I read
various books to create my understanding regarding the scabies like;
Preventive and social medicine - Parks text book.
Where there is no doctor.
Notes of doctor Ravi D’souza on scabies.
wikipedia
NDTV.com. etc
121
Doctors of the JSS helped me to diagnose the scabies patients, in the OPD I
sit with them and asked my doubt regarding the scabies. In the field the health
workers and village health team of Jan Swasthya Sahyog helped me to
identify the scabies. I also discussed about the treatment of scabies.
Then I discussed the about the questionnaire with Dr. Yogesh jain, but before
finalize the Performa I did a informal pilot survey. I did some informal visits
and talk with the affected and non affected peoples, to find out the perception
of the peoples about the scabies. Then after having some grass root level
information I discussed with my mentors finalized my questionnaire for the
survey for the study.
Findings of study
Survey has been completed in both Davanpur and Jakadbandha Villages. But
the date remain to be analyzed. It is still in the process, so that I am not able
to present my find on the basis of the data. I have to go back to JSS Ganiyari
and have to plan for treatment of scabies, and health education on scabies in
the hostels of villages. In the absence of the analyzed data, I am presenting
what ever I observed during the survey ;
Davanpur village
Majority of Davanpur village consist from the Gond’s and rest belongs to
OBC’s. Majority of the peoples have Kacha houses, there are 136 household
and more then 1000 population. Education system of has the same condition
like other parts of the country. There is a primary school and with more then
100 children. I found that teachers which were recruited by the govt, on
contract basis for the school of villages called Shiksha karmi were on the
strike against their demands, only one teacher was there to interact with the
children in a single room. There is a Adivasi Ashram up to 5th standard,
where 85 children are studying from different villages around them, here also
the prevelance of the scabies can be seen, and only one teacher is appoint for
these student. This village in two parts one art called Davanpur and second
part called Bandi para. Nearest health center is 26 km away from here. Here
are four hand pumps and four lakes, mainly hand pumps are being used for
the drinking water is used by the people. Prevalence of the scabies
approximately will be 25 to 30 %, first children and second women were the
most affected from the scabies . I found five to seven members in a family.
Many families living together in a big house but small rooms.
122
Jakadbandha Village
This village is 80 km away from the main district bilaspur and 40 km away
from LORMI block of Bilaspur district. This is the highly forested area and
Achahanakmar is the main village govt, of CHATTISGARH has been
declared a century to this pure tribal area. This village is consisting here in
three parts, URAO PARA, BAIGA PARA, and last one is jakadbandha.
Prevalence of scabies in this village is not common. Very few cases I found
which were effected by the scabies. All 96 kach houses were in sequence
their was the proper ventilation in the houses due to small houses people
often expose their personal things like bed and bad sheets in the sun it could
be the main reason of the absence of scabies. Peoples often Migrate for the
search of livelihood on different places. Peoples. Villages get only one crop
during the rainy season. Most of the people are land less labors and depends
on the forest work, which is often has a very low wage.
In both of these villages health conditions are not differ from the others parts
of the area. There no health facilities are available. Peoples are dying from
the curable diseases, like malaria. To cope up with the health problems of the
this tribal and semi tribal area one organisations called Jan Swasthya sahyog
is working since last more then 10 years, a team of like minded Doctors
trained from the one of the pioneer institution of India, had a same desire to
serve the most vulnerable section of the society. After long journey of two in
the different parts of the country finally their journey stopped on the little
place Ganiyari a small village 18 km away form the Bilaspur, the main fast
growing commercial area of Chattisgarh state. Just 100 km away from this so
called fast growing developing area public health needs are not meeting to the
peoples.
123
OTHER ACTIVITIES
■1.
1
J
> JSA Meetings ( KTCC,
STATE )
> MFC / AIDAN
ftilW
> Indian Social Forum (ISF)
.
■
-
.■
•
■
■
i’;
■■
;
Jan Swasthya Abhiyan Meet
Preparatory Workshop for National Health Assembly II
4-6th January, 2007
The Jan Swasthya Abhiyan coalition consists of over 22 networks and 1000
organisations as well as a large number of individuals that endorse the Indian
People's Health Charter a consensus document that arose out of the Jan
Swasthya Sabha held in December 2000 when concerned networks,
organisations and individuals met to discuss the Health for All Challenge.
ISA Is the result the of a conference organized by WHO and UNICEF at
Alma Ata in 1978,where all the developing countries including India were the
signatory of the conference. In this conference all the developing countries
signed that they will provide health for all up to 2000 AD. After the 22 years
later, it realized by the health professionals and developmental activists that
promise made by the govt, in 1978 Is not going to be fulfilled. So that al the
activists at international and national level came together on Savar
Bangladesh in December 2000, in Peoples Health Assembly, where
concerned networks, organizations and individuals met to discuss the Health
for All Challenge, and formed a Peoples Health Movement at international
level and Jan Swasthya Abhiyan which is the part the of Peoples Health
Movement International.
This was the national preparatory meeting for the second national peoples
health assembly, which is going to be organized in Bhopal on 23 to 25 march
2007 in Bhopal. Dr. Amit Sen Gupta gave the introduction of the national
peoples health assembly and following were the main objectives of
organizing this preparatory meeting.
State wise reporting for the rural health watch.
Opening of the dialog books in the assembly.
Group discussion of national books.
State level programme talk
Discussion on the people’s health workshop.
124
Many organizations from the different states presented their programmes
taking place in their state for the preparation of JSA assembly. They mainly
reported about following
Participants of state workshop ; many organizations attended the
workshop and what are the activities in process.
Rural health watch survey of the state : - the state JSA where they
have done their survey presented about it that how the issues they
are picking up like some organizations were interested to take up
the issue of malnutrition, availability of drugs, in the state peoples
health workshop.
Local health assembly
some states were doing activities at local
level and like public hearings at local level with the help of BMO’s
or CMO’s. sensitizations of local and panchayat leaders in different
villages.
District health assembly and state health assembly.
Issues, which will be taken through the state workshop
main
feature of the state assembly will be the public hearings and data of
peoples rural health watch will be presented by the state JSA.
On six of January 2007 JSA announced and launches officially Peoples
Health Assembly (JAN SWASTYA SABHA) in the presence of many health
and developmental organisation’s, NGO’s followed by the press conference
in which different. Mr. Amit sen gupta, Dr. Ajay khare, (JSA joint convenor)
Dr. Mire Shiva organize this meet.
JSA state workshop (Chattisgarh)
From 1/12/06 to 02/12/06
This was the first state level workshop which I attended the meeting of the
Jan Swasthya Abhiyan (JSA) in Dallirajhara Durg distt. Programme started
with the consolidation to the founder of Shaheed Hospital, and then various
topics were discussed in the meeting regarding health 20 to 30 were present
in this workshop and issues that were facing by the orgnisations were
discussed such as human right issue,displacement migration, occupational
health, function of PHCs role of local politics in the management of PHCs
and availability of doctors, medicines blood, Govt, norms and regulation to
manage the blod bank, Janni Suraksha yogna, lack of information of govt,
schemes to the public health personnel diagnosis of T.B. etc the main issues
125
discussed by among the organizations. Each organization expressed the health
scenario and the problems they are facing in regarding field where these
organizations are working. Dr. Anurag Bhargav discussed on the drug policy
of the Govt, and told about how the health of the poor patient are being
exploited, essentials drugs are not available in the market on the name of
branded drugs how the big medicines companies are robbing on the pocket of
the poor people, life saving medicines are continue are coming out form the
criteria of price controlling. Human right issues were discussed in this
meeting. In this concern the Salva-Judum problem and exploitation,
displacement of adivasies from the forest is on the name of development and
interesting is that all these things being done by the govt, is another question
that what the role should be played by the govt, and what the role is govt,
playing, which totally against the democracy and humanity. Condition of
women and girls is being worsen sexual exploitation and gunda gardi of
police persons has no limits on the people and specially of the women who
are help less to live in the camps. Through the ISA people could create the
pressure on the govt, to make more responsible toward their duties and
responsibilities. These conditions is showing that the coalition of health
movements and social movements for the sake of peoples and the nation is
the priority and demand of Humanity.
MFC/AIDAN
27 to 29 dec. 2006
this was the first meeting of its kind in which 40 to 50 professional in the
community health background came together for two and three days from
different parts of the country, sit together and discussed on the public health
education. Before this mfc meet one more meeting called AIDAN (All India
Drug Action Network) took place.
I am not able to give here my reflection regarding the meeting, because CHC
were organizing this meeting and we were busy in the arrangements of the
participants.
On the second day mfc meeting happened. I have to present my reflection
also for this meeting, but again I am really sorry that I didn’t participate fully
in this meeting also, due to management of the whole progamme. But what
ever I attended is not sufficient for my reflection on those rich discussions
126
1
India Social forum
Duration: - 09 tol3th November 2006
Few words - The first WSF was held from 25 January to 30 January 2001 in
Porto Alegre, Brazil, organized by many groups involved in the alternative
globalization movement. The WSF was sponsored, in part, by the Porto
Alegre government, led by Brazilian Worker's Party (PT). The town was
experimenting with an innovative model for the local government which
combined the traditional representative institutions with the participation of
open assemblies of the people. 12,000 people attended from around the
world. At the time, Brasil was also in a moment of transformation that later
would lead to the electoral victory of the PT candidate Luiz Inacio Lula da
Silva.
World Social Forum came in: ATTAC saw the conference as an opportunity
to bring together the best minds working on alternatives to neo-liberal
economic policies-not just new systems of taxation but everything from
sustainable farming to participatory democracy to cooperative production to
independent media. From this process of information swapping ATTAC
believed its "common agenda" would emerge.
A community health fellow I have spent three months and going through the
fourth month in this India social Forum. This is my first experience in this
kind of convention where a lot of groups come on a common platform, and
put their experiences on various issues, which they are facing in their
respective field areas. Many issues discusses such as - development,
displacement & migration of Dalits and indigenous peoples. Discrimination,
Child issues, Women issues, health Issues, Land, Education, Food Security,
Etc. All of these problems have their root in so called Development.
Further I am presenting my reflection on the issues, which I attended during
my stay in convention.
09-11-06: - this was the first day of the convention. In the morning we
completed the process of the registration then visited to the convention
ground. There were many organizations from all over India putting their stalls
and showing their issues, demand charters, books, and signatures campaign.
In the evening the plenary has started and continue till the midnight. Different
social activists express their view on the aims and objectives of the India
Social Forum. Such as our aim is that the present world could be change
where the equity will be every where and no discrimination will be seen on
the name of cast class and gender. The aim of our gathering is that such a
127
r
huge amount of the people suffering by the same problem and their root are in
present system. This system should be pro-people.
10-11-06 :- in the morning of the 10 of November we had to attend the pre
decided session but we were getting difficulty to find out the places, and due
to first day session started some time letter. In the first session I listened to
MEDHA PATKER on the issue of displacement and development. Like
jungle is the property of Acivaises, govt, is responsible for rehabilitation and
it should be the priority of the govt, to look after the displaced majority of
the community who are their own people. Dames the sign of development of
capitalistic society, cement and iron lobby is taking over the govt, machinery.
I went to the 3 screening session where they were showing the movies on the
different issues like Iraq war and protest against COCA COLA, and PEPSI in
the middle East and African countries, Women empowerment, and working
man in the home.
The third session which I attended was on land and livelihood organizing by
Ekta Parishad.
Different Peoples from the different parts of India were putting their views on
problems they are facing due to developmental policies. They were against
the unbalanced development policies of the govt, which is the cause of
migration and poverty of Dalits, Tribels and other backward classes of the
community in different places of India.and put following data of these
vulnerable classes of the community.
Among the population of India, 16 crores are Dalits, and 08 crores are
Adivasi. Over the last 50 years various policies and programmes were made
for their development but still the conditions are not satisfactory, 45%
Adivasi, and 36 % Dalits, communities are facing extreme poverty. On the
name of the development more then 50 million peoples has been displaced
out which 40% are Dalits. Rehabilitation process is still unseen. Govt, of the
states is not paying serious attention; most of the agriculture land has been
captured legally or illegally through the govt, or others land lords. Agriculture
labor is Dalits community but they don’t have their own land, in all of these
processes the conditions of women and children is most vulnerable they are
facing more socio-economical, and cultural problems.
The land reforms and proper decentralized Panchayat system could only the
mean to solve the problems. Only through the community participation in the
governance and community control and monitoring over the public health
services can improve the status of Human life and we can achieve the
development goals.
128
After Noon session (12 : 03 )
In the afternoon session I attended the Jan Swasthya Abhiyan session on
“child health”.
Only good health leads to the development and empowerment. But the govt,
doesn’t have effective policies to improve the health conditions of all the
classes of the community at all levels, in the context of the child health only
internationally funded programmes like Pulse Polio, and HIV/AIDS are
being focused polio vaccine is include in primary vaccination given right
from the birth of the child, But because of UNICEF is funding for this
programme, it has became a separate national programme. Primary data of
NFHS - 3 shows that routine vaccination is falling, Govt, bodies concerned
are not conformed about how many dose are required for the child. After the
vaccination polio has seen in some cases. Human Rights organisation
considering that it is an issue for of Human rights violation. A lot of lacunas
are in the pulse polio campaign like polio is a disease concerned with the
water, infection happens due to lack of sanitation and open sewage system,
but in this campaign water issues are not being address. There is not any
provision in the campaign to solve Nutrition and other health aspect properly.
Besides all of these programmes regarding Child Health, Malnutrition, Infant
Mortality Rates, Safe Drinking Water and Sanitation, issues are interlinked
and concerned with the Child Health, and by the time becoming more severe
only through strengthening of public health system, maximum people of the
community who are marginalized, most vulnerable and prone to the diseases
could be served. Other important thing is to understand the nature of
programme, creating awareness in the community and realization of
importance of the programme are the factors effecting to the programme.
After Noon (4-7) (11-11-06)
Urban Health in the context of Globalization.
Due to Globalization and Development health is affecting very much in both
urban and rural areas. Same the conditions of the slum peoples are getting
verse, they not very good. Now the urban renewal mission is contributing
more and creating problems more severe, slums are being displaced and govt,
and corporations are escaping to take the responsibility of rehabilitation and
is not providing basic public health services, like water supply, power supply,
sanitation, and health care services etc. These problems are together effecting
on health and the living conditions of the peoples of slum community.
129
On the name of urban renewal mission Rs. 5000 crore are allocated for the
master plan of 60 cities of India. It is estimated that there are 40 lakh labors
are in Delhi and due to high migration rate in next 20 it will reach up to 40
lakh, but according master plan Delhi govt, will not establish or will not
invest in any which could be helpful to provide the employment to the labor
class.
On the name of development in lucknow a slum has been displaced by the
order of high court. Due to high cost of medicines lay mans are not able to
afford health treatment, free of cost treatment is not available in govt,
hospitals, medicines are not available their. 354 medicines falls in price
control in 1977, but in 1995 only 74 remains under it. Now the public private
partnership is a biggest source of earning money, live example is Appolo
hospital. Delhi Govt, has 23 crores yearly income, by the investment of 47
crores. But the treatment of the common man is still a dream to avail the
facilities or treatment, due to expensive treatment.
Diseases are becoming more then earlier days, now due to these peoples are
dying, water level is getting down and due to development earth is getting
recharge, rain water is not being stopped, with the concept of water
harvesting peoples are still not familiar and facing the problem of water
scarcity. Drinking water is not available; public health services are poor,
privatized water supply contributing in the problem to be more serious.
Ground water is getting contaminated continuously due to industrialization
and Slums people are helpless to use this water. Not any international
agencies are taking these problems seriously and coming together to raise the
voice against the govt, policies, corporate, and industrialists.
Saving India’s Public Health
Public health system is the only system by which we can reach or serve to the
maximum number of peoples with appropriate and affordable cost. Now the
public health policies of India’s is not in the hand of our policy makers or has
been hijacked though the structural adjustment programmes (SAP) of US
agencies like World Bank and IMF. Now the community is the only hope to
save the public health system. The democratic and decentralized system of
the country provides the opportunity to the peoples to strengthen to the
system whether it could be health, Education and others. Community
involvement in the health programme, through prioritizing needs, decision
making, planning, implementation and monitoring could play the major role
to save the public health system of the country.
130
In this process National Rural Health Mission (NRHM) could be mile stone.
The concept of the ASHA, community health workers, and public private
partnership, is trying to ensure the community participation in the public
health system.
But the lacunas are still being seen, state govt, is not looking interested to
implement the process of the NRHM selection of the ASHA health workers
is not properly taking place. Surpanch and other panchayt members is
demanding money up 3000 to 5000 for the selection of ASHA workers.
Where the ASHA workers have been selected, still not getting proper
trainings, and assuming like the assistant of Anganwadies or ANM’s. Unless
the community will take part honestly, we can’t expect success of any public
health programme. A lot of problems are in the community, and resources are
limited. Therefore maximum utilization of resources is possible only through
the community participation for the development.
Conference on Right to Education (Morning) (11-11-06)
Modern right to education bill 2006
Education is one of the most important fundamental right of the people, and
subject of the state to provide free and compulsory education to 6-14 years
children.
but with the development it is looking like a dream to have free and
compulsory education, in the present era privatization is breaking the back
bone of the education system. Modem right to education bill 2006 is working
as a strong Jake for the irresponsibility’s of the govt, and has washed all the
dreams of good and quality education. 11th five year plan says “that we have a
lot of opportunities in the Information Technology sector, because we
working 24* 7 for the Americans professionals, so that education should be
technology based that will help to the capitalist to invest in the education
sector and it will becomes more privatized on the name of providing good
and quality education.
Due to facilitation of the private market govt, is keeping down their hands to
ensure the privatization.. At one hand this Act has provisions to take and
action against parents who are not sending their children to school, on the
other hand govt, is not doing any provisions and don’t have any policy or
programme to reduce poverty for the families where their children are the
only source of income. Bill is saying children of the families who don’t have
residential proof will not be able to get admission in the schools, then what
about thousands of labor families who are migrating every to search of food
131
and livelihood. Govt, will not open any school where private schools are
existing. This is the policy to promote the privatization of the education.
Girl child labor in the so called developing nations, the conditions of the
girl child labor is getting worse, especially in the backward areas where they
are working as a bounded labor, there are a lot issues regarding girl child
labor like- advance credit, lack of food accessibility, customs and traditions,
and dowry, are the biggest cause of the girl child labor, early marriage, heavy
house hold work, early pregnancy, long working working hours, agriculture
activities, are keeping them away from the education, some data says that
women in the villages takes 4 to 5 hour sleep, during night, and it is more
harmful during the pregnancy.
Dalit Education.
Education is one of the best tools of the development. Education teaches men
about the life and help men to accumulate in the society so that education is
for every one and it is a fundamental human right.
But right from the beginning a particular section of the society is keeping
away from education, and they had not any right to have education in ancient
period, only good education was available only for the rich and economically
sound section of the society. A particular section of the society who had
power were dominated over all the resources and utilizing it. After the
independence a lot of efforts were carried out for upliftment and the
development for poor, backward and vulnerable sections of the society like
Dalits minorities, and tribals. Under the section 14 govt, is responsible to
provide free and compulsory education upto 14 years children. But now it is a
dream to get quality education in govt, schools, in rural and out reach areas,
govt, is coming out from the responsibilities to provide education, and
handing over it to the private sectors, which is being used as a money making
machine. Education field is developing like a business sector, business men
are investing on it, good and quality education is available only in big schools
who r charging high fee to its students. In this scenario good and quality
education is a big dream to the peoples who are living in the out reach and
rural areas. They can’t even think for this type of education, beside all of
these problems the cast system is making worse difficult for Dalits and
Adivasi students, where the these problems like Dalits and untouchables are
exist, teachers don’t behave properly with dalit students, almost all the bed
work like sanitation, sweeping, fetching water, falls into account of dalit
students. In the rural areas of Rajasthan and Gujrat, teachers don’t like to
teach dalit students.
132
I think the main problem is existing in power relations. In the rural areas if
power will be in the hand of the locally dominant or a particular group they
will think for development for their own class or section to eradicate the
problems democratic approach could be one of the solution, but where we
want to development of particular marginalized and vulnerable group power
structure should be according to need of the community for their
empowerment their own involvement in decision making and planning are
must and they have to be understand or realized that this is their own
programe.
For the development of the vulnerable and marginalized sections it is must to
develop the structure according to their need. Resources must be hand over to
them and govt, should monitor and assist only in the planning and
monitoring. In case of the education of the dalit section, the dalit majority
will be responsible for the education of the dalit section, or at least
monitoring should be done through the dalists peoples.
National Alliance for Right to Education and Equity.
By Professor - YASHPAL
Education is one of the most beautiful concepts of the world. Man should
always think positive because positive thinking infinite possibilities for
instance globalization is creating disparities around the globe between rich
and poor man and Human societies. But with the positive thinking one can
beautiful and best possible use of this globalization, like we can connect our
villages through the internet. It will helpful to disseminate information
regarding health, education, employment, agriculture, etc. govt, should work
toward it if we want to development.
there is infinite possibilities, because Universe is infinite. Hope comes from
the possibilities, so that the death of hope is a unscientific thinking. Hope
keeps you alive and motivate for the invention.
National Coordination Committee (NCC) meeting of Jan Swasthya
Abhiyan (JSS).
Place
Indian Social Forum
on 13 of November 2006, evening NCC meeting of Jan Swasthya Abhiyan
conducted during the ISF convention. Attendant of the meeting were the
133
social health activists from various organizations working in the field of
health in the different parts of the country.
Dr. T. Sundar Raman, Dr. Abhay shukla, Dr. Dhananjay, Dr. Joe Varghees,
Mrs. Indira, Dr. Vandana Prasad, Dr. Ajay Khare, mr. Sant, Mr. Naveen
Thomas, Mr. Rakesh Chandore, Mr. Juned Kamal Etc.
Main Issues discussed in the meeting;
Peoples Rural Health watch survey : most of the organizations are still
working at their own level and it almost has competed. This survey has been
completed in Madhya Pradesh and Rajasthan, under the rural health watch
states who didn’t complete the will complete it a soon as possible, or up to
the End of December 2006. So that it will be helpful to prepare the report for
NHA - 2.
Circulation of Action Alert:
this magazine was started to up date and
strive the health information and health activities among the partners and
other organizations directly or indirectly concerned with Jan Swasthya
Abhiyan. Earlier it was continue, but interrupted in between due to problem
to access of the internet or mail services, but now it will be continue from the
JSA secretariat.
National security registration Act.
Public Private Partnership task group. Alternative action plan has to frame for
this task group. Community monitoring is also one of the tool to look after
PPP implementation. Many programme national wide are running without
knowing its effects on health of the community, like Pulse Polio campaign,
National malaria programme, T.B. programme, etc.
Preparation of National Health Assembly (NHA) - 2.
Place -
Ravindra Bhavan, Bhopal, Madhya Pradesh.
Dates -
23rd to 25th March 2007.
there is
Funding - finance is a back bone of every programme.
approximate estimate for NHA - 2 is about 25 lakh, this is quite a big
amount, so that different organizations by representing their states will
contribute for NHA - 2. others suggestions that are comings, that many
organizations could do funding for this programme, but the problem is that all
the organization who are capable for the funding, are being criticized for their
134
role in the health field, so that the funding of the programme is a big
challenge before JSA.
some suggestions that will be implement during and before NHA-2 are
follows,
registration fee will be charged on the participants, some funding
organization will be contact like TATA Trust, CRY, and ICICI bank, for
funding under the supervision of a task group formed at secretariat level.
Translation of NHA-2 books for new books written for the NHA 2 will be
translated in to Hindi and local languages, book no. one Globalization and
health came into account of BGVS M.P. for the Hindi translation.
State Health Assemblies
organization in their each respective states
will conduct public hearings up to the January 2007. organizations will plan
according to that, and will send programme to the JSA sec.
National Secretariat A national secretariat will be formed for the National
Health Assembly - 2.
Following members will look after the work of National Secretariat.
Dr. Ekbal, Mr. Naveen Thomas, Dr. Ajay Khare, Dr. Vandana, and Mrs.
Deepa, Dr. Dhananjay, Dr. Joe Verghees, and Mr. Tejram.
Another important section of Indian Social Forum that was organized by the
JSA simulteneously was organized by the people
Conclusion:-
In the end of this report I would like to say that India Social Forum is a social
congregation and provide a plat form where various groups working in the
country on the different issues came together to see a dream of another world
where equity, respect, equality, equal distribution of resources, equal
opportunity, or in a one word equal world without discrimination will be a
reality.
It is good to come together and to make realize or aware to others regarding
the actual problems of the society or community, but if we will critically
examine to this problem, then we will realize that this was congregation of
cattle’s, where lots of cattle’s in small crowd were roaming and enjoying
only. In the program halls there own peoples were listening to them, most of
the people don’t know what is going in the next programme hall. Some
popular social activists had covered all the crowd. Various programme which
I wanted to go could not start due to lack of peoples, in the last which I felt
135
that lack of togetherness in all the groups, we are living in the society,
directly or indirectly we are fighting from the globalize forces, our enemy is
same then why we are fighting separately. We should have to be together; our
linkages will provide us support and will be helpful to be strengthening our
movement. There was not any agenda came into existence on behalf of India
social forum, that what will be the future strategy of the movement and how
we have to fight in the future.
Presence of media without any coverage even in local news paper is another
question in India social forum that why it did not happen. Why the media was
not giving coverage, media is a strong source of democracy then why media
is not being allowed to expose the social problems. This had done by media
with consciousness or without consciousness?
I have to know the answer of all above questions. In a movement each and
every step must be discussed for the success. Especially to the organizations
who are working on the health field.
136
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Learning’s and Conclusion
_____
During this fellowship programme I interacted with various people’s
organizations, and various programmes which contributed in my experience a
lot, other wise I may not be able to get all these things in a very short time.
This all took place through my fellowship programme. For this I am very
much indebted to Dr. Thelma Narayam, Dr.Ravi Narayan and all CHC team.
Followings are my learning during my six month’s period.
Each of these have its very vast range of the topics:
• Understanding regarding community: - community it self is very
complex thing. In this Fellowship programme I went through various
experiences, which helped me to learn about the community.
Community is not only the group of peoples which live together,
interact with each other share their experiences and have some kind of
relations. They live in different places, some peoples migrate like
Banjara community and some prefer to be together. For the control
over the society they have some rules and regulations. If these rules
and regulations come in to hand of people who are not community
oriented then this is the starting point of the problems from where the
clashes and issues get started. Therefore as a community health activist
our role is to always try to build community. Use of life skills will be
helpful for problem solving and conflict resolution. We live and
believe in democratic system, because it gives the freedom to put own
view and critical thinking for the betterment and development of the
community.
• Community health is a process to involve the community to take up
the responsibility to providing the services for their own health. This is
a pure community owned action which helps people to mobilize the
community towards common action. This is the involvement of all the
community members together in decision making, planning,
monitoring, implementation and evaluation, without any discrimination
of caste, class and gender. This is community effort to make the
community take responsibility for it self.
• Public Health
it is an organized community effort which not only
demand for the services form the system, but also responsible for the
health of community. What ever the requirements of a large
137
community required to live the satisfactory and standard, life with
dignity comes under the public health. Therefore fulfillment of these
requirement not only public health services are responsibility but also
community itself to provide and to demand for over all development of
the community. This is the primary responsibility of the govt, to ensure
all these services to the community.
• Community Based Rehabilitation (CBR):- during my first placement
in the community based rehabilitation forum (CBRF) I got an
opportunity to learn about the community Based Rehabilitation. It is
the process to sensitize community for the persons with disabilities
their requirements, needs, to stop discrimination, to spread solidarity
and the integration of persons with disabilities in the community and
the family itself. As a health point of view we can say that for the
development of the society and community health it much more
necessary the involvement of every person of community in each and
every process of community initiation. It the process of maximum
utilization of available resources. Which help to plan every thing in a
holistic manner for the development of the community.
The Persons with Disability (equal opportunity and protection of rights and
full participation) Act 1995 is a milestone in the field of disability. This is the
first Act, talks about the rights and entitlements of persons with disabilities
and provides the opportunity to them to participate in the community with
their full potential and abilities. Persons With Disability Act 1995, was one of
my area of interest in the Community Based Rehabilitation Forum, which
helped me to learn about the rights based approach of persons with
disabilities. Through the study on the disability I came to know the reality of
PWDs all over India. For the development of persons with disabilities CBR
Forum is a platform to provide financial and technical assistance to the
organizations who are working for the development, upliftment, and
integration of PWDs in rural areas, such as Centre for Overall Development
(C.O.D.) a NGO in Thamrassery panchayat Kozikod Distt. Kerala. Providing
financial assistance to PWDs to perform this activity organization is running
a fan manufacturing unit. In this unit 12 workers out of 30 are PWDs. This
organization is going to integrate the rights of PWDs in their other projects.
Understanding about the rural community and village health workers
training have taught me various lessons, that how members of the
community could be dedicated toward their work. In consequence I want
to share one of my experiences;
138
During my field placement in the JSS, one day on field visit 80 km away
from the main centre Ganiyari and 100 km away from Bilaspur, a woman
was suffering from severe anemia. She was living in a small hut of 10
ft 10ft. Her blood test showed only three gm hemoglobin was in blood.
Earlier two children have died and this time too her child has died during
the birth. When health worker went her home and requested her to come
with us for the treatment, she did not agree, as she cant go out with out any
known person and permission of her husband. Then the team member of
JSS requested other women to come with her. Then she agreed and came
to Ganiyari main hospital. In Ganiyari another trouble was that we were
not getting anyone to donate her blood. The same blood group was also
not available in the hospital. Then two persons including me donated
blood to save her life.
That she was not agreeing to come from the village has many reasons like
her family was very poor, a women cant go out with out the permission of
her husband, distance of health centre from the village, public transport is
not available up to 25 km from the village. And after 25 km only few
transports are available. Beside this cultural and traditional factors also
effect on the health of people. Lack of food is also one of the major
reasons for malnourishment of the woman. People have to migrate for
their livelihood. All these factors are the determinants of health that
worsen the life of the community.
If our village health team did not reach the woman, she could have died.
Other learning’s were about the importance of the following:
■ Understanding about Social and Health Movement.
■ Rural health conditions in the villages.
■ Execution of the village health programmes.
■ Health training of the health workers.
■ Local customs and traditions.
■ Community health system.
■ Public health services.
■ Appropriate technologies.
■ Food habits of the in the rural areas.
■ House hold information of the villages.
■ Economical conditions of the villages, especially about the tribal areas.
■ Education level in the rural areas.
■ Concept of phulwari.
■ Malnutrition and public health.
139
JUNED KAMAL
Community Health Fellow,
Community Health Cell, (CHC) Bangalore.
Agency
Duration
Jan Swasthya Sahyog (JSS)
November, 2006 to February, 2007.
Week 1& 2 -
Orientation of the Jan Swasthya Sahyog,
activities
Observation of different aspect of JSS work.
Patient care
--------
Out Patient
In Patient
Laboratory
Appropriate Technology
Out Reach Work ----------
Village Clinic
Health Work
v^uiiiinujiiLy iiectibh Section
Week 3 & 6th -
Project on epidemiology and control of Scabies
Objectives
Methodology
Primary Steps
Health Education
Treatment / Management
Follow up
Documentation
Week 7th
Presentation of findings of the project.
and its
EPIDEMIOLOGY & CONTROL OF SCABIES
Objectives >
1
To study the epidemiology of scabies in
i a community, related specially to the
following —
- Age
• Educational level
■ Family Size
■ Occupation • Community Group
■ Income Level
■ Awareness / level of Hygiene and sanitation.
■ Sex
2
3
To plan, design, and conduct a health education campaign on scabies, cause,
spread, treatment, and prevention.
To control scabies in the community.
Methodology
1
2
3
4
5
6
7
8
Identify one or two villages with a high prevalence of scabies.
( Total population approximately 1000 - 1500 )
Design a proforma for a house to house survey of the disease.
Read available
literature
-------------------e on the Scabies and be well acquainted with facts of the
disease.
Conduct a survey for the disease to determine the above epidemiological features
incidence and prevalence.
Plan design and conduct a health education campaign on the scabies>
Preparation of health education material in the local language.
- Health education sessions at individual, family, and community level, on
cause treatment and prevention of the disease.
Awareness level before and after health education.
Control of scabies in the community - mass treatment campaign followed by a
rapid assessment of control methods.
Prepare a report on the survey and the control measures.
Presentation of the report.
Preliminary Steps
1
2
3
4
Procure medicines to treat scabies - GBH lotion, gentian violet solution,
cotrimoxazole tablets.
Read available literature on Scabies.
Notes on Hindi and English,
Text book of preventive and social medicine (PSM) Park.
Where there is a No-Doctor.
Design a proforma for use in survey.
Design health education material on scabies.
CBR Forum's
view of CBR
Basic Principles
of a CBR Programme
i.
Enabling services at the home settings of Persons with Disabilities (see Annexure A for
details).
2.
Capacity building of local human resources, especially PWDs to provide services.
3.
Delivery of optimum quality of services which will build on the traditional good practices of
rehabilitation.
4.
Ensure that the community who benefits from such services gradually takes over the
responsibility of managing rehabilitation programmes.
5.
Ensure participation and involvement of Persons with Disabilities in Planning, Monitoring
and Managing the programmes.
6.
CBR programmes must be flexible so that they can operate at the local level and within the
context of local conditions.
7.
Local resources should be tapped to the maximum.
8.
Ensure that the rights of PWDs are not denied.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 1 of 1
Essential Components
of a CBR Programme
1. The programme should cover all types of Persons with Disabilities of age groups who
need rehabilitation services (see Annexure 2 for details).
2. The programme should have a multi-sectoral approach having health, education, economic
programmes and social integration interventions.
3. The programme should have access to or generate a good and effective referral system.
4. The programmes should aim at full integration of the Person with Disabilities into his /
her community.
5. The programme needs to have committed and well trained community members as
service providers.
6. The programme should have gender and disability focus and balance. (Special attention
to care for needs of women and girls.)
7. The programme should strike a balance between provision of service delivery and
empowering the person with disability, family and community through regular
transfer of skills.
8. The programme should ensure that the rights of the Persons with Disabilities are not
denied through advocacy at local, state and national level.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 2 of 2
Rehabilitating a PWD in a holistic manner
Two dimensions: society and the individual:
When planning out the rehabilitation of a PWD in the above context it is important to look at the situation in a holistic manner.
In drawing up an Individual Rehabilitation Plan, it is important to ensure that:
(a) the social dimension is looked into to enable the PWD to function effectively in society and
(b) all the areas of growth of the individual PWD (and all his / her needs) are attended to.
It is with the above in mind that adequate interventions have to be planned both at the societal and individual level. For instance,
while the community is made aware of the need for prevention through inoculation, the staff of the local PHC have to be available
to ensure that the inoculations can be administered. Again, while the individual PWDs need for mobility through provision of aids
and appliances (crutches, calipers, walkers, wheel chairs) has to be cared for, the need for society to ensure that there is
accessibility through provision of good roads, ramps, railings etc. has to be looked into.
Holistic rehabilitation through all six areas of growth :
When planning interventions we also have to bear in mind that we have to give attention to the needs in the following six areas of
growth:
(1) Physical
(2) Psycho-sexual
(3) Intellectual
(4) Socio-cultural
(5) Economic
(6) Spiritual
It is to be noted that holistic rehabilitation will be a reality only when needs in all these areas of growth are cared for.
Listing of needs under all six areas of growth :
Against each of these areas of growth, the societal needs that have to be cared for have been highlighted and individual needs
have been listed. It is to be noted that this listing of societal needs / individual needs is not an exhaustive one but a pointer of the
methodology to be followed. The individual's need will be realized fully only if the societal dimension is fulfilled. They are two sides
of the same coin.
For instance under the area of Physical Growth, the societal needs to be cared for are:
(I)
Appropriate Health services and Accessibility in family and society.
while the individual needs listed are:
(1.1) Prevention of disabilities and secondary complications and
(1.2) Physical assessment, intervention and mobility.
Listing of CBR interventions under all six areas of growth :
Specific interventions have then been suggested to realize each need at both the individual and societal levels. For instance the
interventions listed under the societal dimension:
(I) Health services and Accessibility in family and society are:
Awareness to the community
Family counseling
Working with PHCs
Training of Dhais
Medical camps with Govt, machinery / local resources
Ramps in public buildings / other modifications to make society accessible (visuals)
while those listed under the individual need:
(1.1) Prevention of disabilities and secondary complications are:
Immunization
Early Identification, Intervention and Infantile stimulation
Antenatal / Postnatal care
Genetic Counseling
Nutrition
It will have to be borne in mind that the above interventions will have to be CBR in nature. This would imply an implicit planning
as to how the PWDs, their family members and the community could be involved in each of the above interventions.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 3 of 3
The Social Model of Rehabilitation
Ila. Personal Growth opportunities
and Marital customs
in family and society.
\llb. Inhpeisonal ulationship
\ with femily, peers,
\ community.
The
Social
Dimension
r\
4
Ajepoe pob Apnum
^^uny©ddo A
Mm
cbr Forum's
view of cbr
: Mr. Nicholas Guia Rebelo
Page 4 of 4
2.1 Increased srfesta
self confidence
22 Self
Detemwafon
2.3 Sexual
\ (Procreatioi
The
Individual
Dimension
WK
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 5 of 5
Areas of growth, needs and interventions
A.
Area of Growth: Physical
Societal level:
I.
Need : Appropriate Health services and accessibility in family and society
Interventions:
Awareness to the community__________________________________________
Family counseling____________________________________________________
Working with PHCs__________________________________________________
Training of Dhais____________________________________________________
Medical camps with Govt, machinery / local resources_______________________
Ramps in public buildings / other modifications to make society accessible (visuals)
Individual level:
1.1
Need: Prevention of disabilities and secondary complications
Interventions:
Immunization__________________________________
Early Identification, Intervention and Infantile stimulation
Antenatal / Postnatal care_________________________
Genetic Counseling______________________________
Nutrition
1.2
Need: Physical assessment, intervention and mobility
Interventions:
0=3 Medical assessment__________
Activities of daily living skills
Therapeutic interventions:_____
Physiotherapy___________
Speech and language_____
Occupational therapy_____
Orientation and Mobility training
Aids and appliances__________
Surgery___________________
B.
Area of Growth: Psycho Sexual
Societal level:
II.
Need : Personal growth opportunities and marital customs in family and society
Interventions:
Creating local resources (counseling cells / training sessions) to care for the growth of individuals
Pro active action by Government agencies
__ _____________________________
Family counseling
__
_
Training school teachers / leaders / local doctors to impart sex education
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 6 of 6
Individual level:
2.1
Need: Increased self esteem and self confidence
Interventions:
Counseling (to accept disability / understand limitation / realize ability)
Personality development training___________________________
Leadership training
2.2
Need: Self determination
Interventions:
Knowledge of rights, privileges and responsibilities______
Organization of movements of PWDs / Community Groups
Advocacy and empowerment_______________________
Federation of PWDs
2.3
Need: Sexual (Procreation)
Interventions:
Genetic counseling
Marriage counseling
C.
Area of Growth: Intellectual
Societal level:
III.
Need : Educational opportunities in family and society
Interventions:
Provision of formal / non formal inclusive education opportunities
Provision of special education opportunities__________________
Provision of skill / vocational training opportunities____________
Awareness to Principals, Teachers, Peers and Parents
Individual level:
3.1
Need: Intellectual development
Interventions:
Infantile stimulation_______________________________________________________
Early intervention_________________________________________________________
Admission into educational / skill training / vocational setups as per need / functional level
GBR Forum's
view of GBR
: Mr. Nicholas Guia Rebelo
Page 7 of 7
D.
Area of Growth: Socio cultural
Societal level:
IVa.
Need : Social and family expectations^ prejudices, beliefs
Interventions:
Awareness to community / family on superstitious beliefs / myths.____________
Awareness to community on disabilities, modes of communication with PWDs etc.
Attitudinal change of the family / community
IVb.
Need : Cultural practices in the family and society
Interventions:
Provision of opportunities for PWDs to take an active part in cultural events_____
Sensitize local cultural troupes to train and include PWDs in cultural performances
Individual level:
4.1
Need; Interpersonal relationship with family, peers, community.
Interventions:
Develop communication skills
Promote play activity______
Creation of recreation clubs
4.2
Need: Learn and adopt age and situation appropriate behaviour
Interventions:
Counseling and guidance
Behaviour modification
4.3
Need: Participate in the cultural life of the community
Interventions:
PWDs attend and take an active part in cultural functions
E.
Area of Growth: Economic
Societal level:
V.
Need : Opportunities for economic gain made available by family and community
Interventions:
Opportunities for vocational training / skill training__________
Income Generation Programmes________________________
Availability of local resources / Government schemes________
Disability friendly policies of financial institutions / Government
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 8 of 8
Individual level:
5.1
Need: Earning member of society
Interventions:
Pre vocational training____________________
Vocational / skill training__________________
Habit of savings_________________________
Mobilize local resources / Government schemes
Networking with financial institutions________
Income Generation Programmes____________
Placement / Self Employment
F.
Area of Growth: Spiritual
Societal level:
VI.
Need : Spiritual practices in the family and society
Interventions:
Opportunities for religious education__________________________________________
Accessibility to places of worship_____________________________________________
Create opportunity to participate in religious rites / practices_______________________
Counseling, if needed (not to blame God for disability / not a punishment of previous life)
Individual level:
7.1
Need: Meaningful relationship with God / Nature
Interventions:
Take steps to obtain religious education
Join family / community in places of worship
Participate in religious rites / practices
Conseling, if needed.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 9 of 9
Drawing up a Rehabilitation Plan
Partner's have been invited to use the above input on holistic rehabilitation to draw up plans for the
rehabilitation of PWDs.
(A)
Status before intervention:
Status: Needs
before intervention
1.1
1.2
Interventions
made
1.1
1.2
Process
followed
1.1
1.2
Linkages
established
1.1
1.2
The partner organization needs to begin by determining the status of the individual PWD and the milieu in
which he / she lives before intervention. In order to do this effectively the partner has to determine:
(a) the interventions made by the PWD to realize his / her needs,
(b) the interventions made by the family and the community to enable the PWD to realize his / her
needs,
(c) the process in which these interventions were made and
(d) the type of linkages that were established in the process.
In order to do the above the partner will have to dialogue with the PWD, his / her family and community
members.
(B)
Plan for intervention:
Plan: Needs at time
of intervention
1.1
1.2
Planned
interventions
1.1
1.2
Foreseen
process
1.1
1.2
Desirable
Linkages
1.1
1.2
After obtaining a clear picture of the status of the family, the society and the individual PWD before
intervention, the partner organization has to take steps to draw up an effective intervention plan. This plan
necessarily has to build up on what has already been done earlier. Here too the PWD, his / her family and
community members have necessarily to be involved if we speak of a true CBR intervention.
Here the partner needs to determine:
(a) the needs of the PWD at the time of intervention,
(b) the needs to be cared for by the community to enable the PWD to realize his / her needs
(c) the type of intervention required to answer these needs,
(d) the process to be used for each specific intervention so as to ensure that the intervention is
CBR in nature and
(e) the linkages that need to be established to ensure greater efficacy and sustainability.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 10 of 10
(C)
Actual intervention. Impact and Future plan:
Foreseen
Needs
at time of
intervention
1.1
1.2
Actual
Interventions
made
1.1
1.2
Other
Needs
perceived
at time of
monitoring
Planned
interventions
1.3
1.4
1.3
1.4
Process
followed
1.1
1.2
Foreseen
process
1.3
1.4
Linkages
established
1.1
1.2
Impact
1.1
1.2
Future
course of
action
1.1
1.2
Desirable
Linkages
1.3
1.4
Having drawn up the rehabilitation plan the partner organization will have to ensure that the plan is
monitored at least every six months. The PWD, his / her family and the community will have to be involved
in the monitoring process.
The monitoring groups will have to determine:
(a) which of the needs of the PWD the partner organization has attempted to answer,
(b) the type of intervention made to answer these needs,
(c) if the process used for each specific intervention was CBR in nature,
(d) what linkages were established to ensure greater efficacy and sustainability,
(e) the impact of each and every intervention in the life of the PWD (Eg.: if aids and appliances
were give, how has this brought about a change in his / her way of life?) and
(f) the future course of action to be taken, if any.
Understandably, the PWD may have become aware of other needs along the way. Hence, here the
monitoring team has to determine:
Here the partner needs to determine:
(a) the new needs of the PWD at the time of monitoring,
(b) the new needs to be cared for by the community to enable the PWD to realize his / her needs
(c) the type of intervention required to answer these needs,
(d) the process to be used for each specific intervention so as to ensure that the intervention is
CBR in nature and
(e) the linkages that need to be established to ensure greater efficacy and sustainability.
(D)
Learning:
Having gone through the above process the partner organization, PWDs, their family members and the
community will have to document the lessons they have learnt. This process of documentation will help the
PWDs, families and community become aware of their own potentials and capacity to take forward the
programme. It will also be a learning tool for others to emulate.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 11 of 11
Annexure A
Basic Principles
of a CBR Programme
1.
Enabling services at the home settings of Persons with Disabilities
IBR has its limitations in terms of coverage, high costs and location mostly in urban areas to meet the need
of Persons with Disabilities who mostly live in rural areas. Enabling services at the home settings of Persons
with Disabilities would have the following advantages:
a.
Services can reach a maximum number of Persons with Disabilities of all ages, all types of
disabilities (physical, sensory and mental) and both sexes. The Persons with Disabilities are taken care
of in their own community and familiar surroundings without being segregated in an institution
where their interactions are mainly limited with others having the same disability.
b.
Interventions are provided by family members and the community with external
professional guidance. Family integration and integration with a non-disabled peer group and
community will enhance a smooth social integration without many of the emotional or behavioural
problems.
c. It provides a wide range of opportunities for the Persons with Disabilities for full
participation and equalization of opportunity.
d. The Persons with Disabilities are also exposed to the day-to-day risks. This equips them with
confidence and teaches them skills to overcome problems and achieve their rehabilitation with
maximum self help.
e. The integration process right from the early stages helps to achieve the rehabilitation of
Persons with Disabilities.
f.
2.
It gives an opportunity to the community to develop awareness about (a) the developmental
needs of Persons with Disabilities, (b) the skills they need to acquire, and (c) knowledge about
integration itself.
Capacity building of local human resources, especially PWDs to provide services.
One of the principles of CBR is to demystify the technical skills of professionals and train community
members so that the needs of persons with disability can be met in their own communities to a great
extent. Moreover, the chances that the programmes will sustain are greater, since the trained
community members are more often than not likely to live there without migrating.
The need to train community members to provide interventions to Persons with Disabilities from the
community arose due to the following reasons:
a.
The dearth of qualified rehabilitation professionals in our country.
b.
The few who are trained are mostly urban based or go overseas for better career prospects and more
often than not would not like to live and work in rural areas.
c. Most Persons with Disabilities cannot afford to meet the cost of professional Interventions due to
their economic conditions.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 12 of 12
3.
Delivery of optimum quality of services which will build on the traditional good practices
of rehabilitation.
One of the principles of CBR is to make the interventions cost-effective without compromising on
quality. Care should be taken to build on the traditional good practices of rehabilitation keeping in
mind the customs and beliefs of the target community. Bear in mind that only those customs and
beliefs that are good for rehabilitation have to be picked up and applied to make rehabilitation effective and
acceptable:
a.
In the area of pre, post and ante-natal care the traditional birth attendants could be trained which
would help in prevention of disabilities.
b.
The traditional diet of the target community can be studied and built upon to make the diet more
nutritious in order to prevent disabilities caused due to malnutrition.
c. Some herbal medicines and other forms of treatment that are practiced in the community can be
studied and if proved to be effective in improving the physical condition or in the prevention of
disabilities can be promoted.
d.
Aids and appliances can be used making use t
of' locally available material, which would perhaps be
more suitable for the conditions in the community.
e. Tri-wheelers, trolleys and other play material that are made for children who are not disabled can also
be used effectively for children with disabilities. This not only helps in early stimulation and play
therapy but also helps in social integration with peers.
4.
Ensure that the community who benefits from such services gradually takes over the
responsibility of managing rehabilitation programmes.
4.1
In order to achieve this, the local community should, from the beginning be involved in
planning and service delivery to Persons with Disabilities. The community should recognize
the needs of the Persons with Disabilities and appreciate their potential for becoming
contributing members if the required opportunities are extended to them.
4.2
Mainstreaming of all activities should occur so that the responsibility for Persons with Disabilities
becomes a part of the community's responsibility for its members regardless of disability.
4.3
Stress should be laid on equal opportunities for Persons with Disabilities and non-disabled persons,
depending on their aptitude, merit and training.
4.4
When the community learns to take care of its Persons with Disabilities, it enhances its own
potential for being a better community.
5.
Ensure participation and involvement of Persons with Disabilities in Planning, Monitoring
and Managing the programmes.
5.1.
It should be made clear to Persons with Disabilities that they are being regarded both as
recipients of service as well as contributors to community welfare.
5.2.
In order to give significance to the involvement of Persons with Disabilities, they must have distinct
decision making roles.
5.3.
Persons with Disabilities must be encouraged to do maximum for themselves as well as other
Persons with Disabilities and their families. In fact, where disability is concerned they should play a
leadership role.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 13 of 13
6.
CBR programmes must be flexible so that they can operate at the local level and within
the context of local conditions.
6.1.
There should not be only one model of CBR because different social and economic contexts and
different needs of individual communities will require different solutions.
6.2.
Flexible local programmes will ensure community involvement and result in a variety of
programme models, which are appropriate for different places.
7.
Local resources should be tapped to the maximum.
7.1
There should be integration, coordination and convergence of all locally available
resources.
7.2
Specialized services or agencies extending services should play only a supplementary role in
the service delivery mechanism and only when such services are not available locally.
8.
Ensure that the rights of PWDs are not denied.
8.1
Various groups of PWDs should join together as a network so as to ensure that they have a
common voice to demand for the rights due to them through advocacy at the local, state and
national level.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 14 of 14
Annexure B
Essential Components of a CBR Programme
The programme should cover all types of Persons with Disabilities of age groups who
need rehabilitation services.
Providing assistance for people with all types of disabilities (physical, sensory, and mental),
for people of all ages, including older people and for people affected by Leprosy should be the focus
of the CBR programmes.
2.
The programme should have a multi-sectoral
i
approach having health, education.
economic programmes and social integration interventions.
Creation of a positive attitude towards people with disabilities: this component of a CBR
programme is essential to ensure equalization of opportunities for people with disabilities within their
own community. Positive attitudes among community members can be created by involving them in
the process of programme design and implementation, and by transferring knowledge about
disability issues to community members.
Provision of functional rehabilitation services: often people with disabilities require assistance
to overcome or minimize the effects of their functional limitations (disabilities). In communities
where professional services are not accessible or available, CBR workers should be trained to provide
primary rehabilitation therapy in the areas of rehabilitation such as Medical services, Eye care
services, Hearing services, Physiotherapy, Occupational therapy, Orientation and mobility training,
Speech therapy, Psychological counseling, Orthotics and prosthetics, Other devices.
Provision of education and training opportunities: people with disabilities must have equal
access to educational opportunities and to training that will enable them to make the best use of the
opportunities that occur in their lives. In communities where professional services are not accessible
or available, CBR workers should be trained to provide basic levels of service in the following areas:
(a) Early childhood intervention and referral, especially to medical rehabilitation services.
(b) Education in regular schools.
(c) Non-formal education where regular schooling is not available.
(d) Special education in regular or special schools.
(e) Sign language training.
(f) Braille training.
(g) Training in daily living skills.
Creation of micro and macro income-generation opportunities: people with disabilities need
access to micro and macro income-generation activities, including obtaining financial credit through
existing systems, wherever possible. In slums and rural areas, income-generation activities should
focus on locally appropriate vocational skills. Training in these skills is best conducted by community
members who, with minimal assistance can easily transfer their skills and knowledge to people with
disabilities.
Provision of care facilities: often, people with severe and profound disabilities are in need of
assistance. When they have no families or their families are incapable of caring for them, in order for
them to survive, long-term care facilities must be provided in the community where they can get the
assistance that they need. Moreover, day-care facilities may be needed to provide respite for families
who either work or need time off for other activities.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 15 of 15
Prevention of the causes of disabilities: many types of disability can be prevented by relatively
simple measures. Proper nutrition is one of the more significant ways of preventing disabilities.
Another important area of disability prevention is the detection of disability in young children and
intervention early in their development, to minimize the effect of impairment. There are many other
areas of disability prevention that are also important. These include activities to decrease the number
of accidents in the home, on the road and at work, as well as other initiatives to encourage people to
pursue healthy lifestyles over the course of their lives. The emphasis on prevention of disability will
not only reduce the incidence of disability, but will also reduce the intensity of the handicapping
effect of disability. This will ensure that available resources can be better utilized for providing
services to the existing population with disabilities.
Management, monitoring and evaluation: the effectiveness and efficiency of all CBR programme
components, both in the community and in the area of service delivery outside the community,
depend on effective management practices. The impact of programme activities must be measured
on a regular basis. People must be trained in effective management practices. Data must be
collected, reviewed and evaluated to ensure that programme objectives are met. In this way, the
success or failure of a CBR programme can be honestly measured.
3.
The programme should have access to or generate a good and effective referral system.
The community will have to identify and establish linkages with the existing systems like:
Health System
Education System
Local Government
Financial Institutions
Training Centres
Business Houses and Industries
Service Clubs and Organizations
Local Markets
Skilled Workers etc.
This would enable them to access their services to improve the quality of life of persons with disability.
4.
The programmes should aim at full integration of the Person with Disabilities into his /
her community.
The CBR programme should aim at identifying the potentials and needs of Person with Disabilities
and providinOg appropriate interventions to optimize these, so that the Person with Disabilities can
live a life of dignity and respect to the fullest of his / her abilities, integrated into all spheres
of life within the limitations of his / her disability.
5.
The programme needs to have committed and well trained community members as
service providers.
Working with parents and families in CBR is a must. To a large extent, parents / families can make
our efforts successful. It is not realistic to say that we will train the entire community. All community
members are not likely to be willing. Therefore it is essential to identify those members of the
community who are committed and willing to give time for the programme on a regular
basis and train them systematically over a year or two, so that they can at least carry out the
role of a CBR worker. If an external organisation is implementing CBR programmes in a particular
target area, it is always advisable to employ as staff people from the same target area. This would
not only make the programme more effective and acceptable but would also in the long
term help in sustaining the programmes.
CBR Forum's
view of CBR
: Mr. Nicholas Guia Rebelo
Page 16 of 16
itgB
CBR intervention with a Hearing Impairment Child Annexure
i
CBR intervention with a Hearing Impairment Child. Annexure
CBR intervention with a Cebral Palsy Girl Annexure
Open Day Activity In the Sanchar Annexure no
Self Help Group Of Persons With Disabilities Activity In the Sanchar Annexure
no
■'I
IO'
■■
I
______ ___
Voice identification activity under the CBR programme, with the hearing Impaired Child
Anoop Das with his mother
Annexure Photo - 4.5.3.4
UP - CBR intervention with C.P. Child Sunny Mondal s/o Chandan Mondal
regarding Daily Living Activities
Annexure ...Photo...4.5.3.1
•
Annexure 4.5.3.5
Harit Rupam Shah, Autistic child with the mail CBR worker and his
parents.
LIST OF ACTIVE PARTNERS OF CBR FORUM
Andhra Pradesh: __________________
Mr. K. Chandrapaui,
Mr. G. R. Gowda,
Programme Coordinator,
Executive Director,
Villages Improvement through Social Action (VISA), Central
CAFORD,
School, Burakayalakota -517351,
Terubayalu, Madakasira, Anantapur District,
Mulakalacheruvu Chittoor District,
ANDHRA PRADESH - 515 301.
ANDHRA
PRADESH.
Phone No.: 08493 - 288 995 / 288 958/ 09440257784
Phone No. (08582) 251010 / Mob: 09440931865
09448029482, Email: caford@rediffmail.com
Email: visa99bkk@yahoo.com_____________________
Mr. K. Nireekshana Rao,
Mr. S. P. Reddy,
SNEHA (Society for National Integration through Education
Executive Director,
and Humanizing Action), Sneha Campus, Bethavolu,
Uma Educational and Technical Society,
Gudivada, Krishna District,
Manovikas Nagar, (Behind)
ANDHRA PRADESH-521 301.
Rayudupalem, Kakinada,
Phone No. : (08674) 246993 / Mob: 09440989714
ANDHRA PRADESH - 533 005.
Phone No. (0884) 2307097 / 2306039 /
Mobile: 09848164779
Email: umamanovikas@yahoo.com;
spreddy@umvk.org____________________
Mr. I. Srinivasa Rao,
Mr. Stephen Livera,
President,
Executive Director,
Chaitanya Jyothi Welfare Society,
Society for Development of Drought Prone Area,
26- 11 /1194, Thyagaraya Nagar,
H. No. 42- 189/1, Vengal Rao Colony,
Vedayapalem, Nel lore,
Wanaparthy, ANDHRA PRADESH - 509 103.
ANDHRA PRADESH - 524 004.
Phone No. (08545) 234272 / 232305
Phone No.: (0861) 2344063 (O) / 2329013 (R) /
Mobile: 09885307263_____________________________
Mr. Pilli Solomon,
CH. Raja Rao,
Executive Secretary,
Secretary,
Brethren Institute for Rural Development (BIRD), Prashanthi
Light for Blind, Opp. M. R. O’s Office,
Nilayam,
Near M.P.D.O. Office,
Domala, Prakasam District,
Valmiki Nagar, Bestavarapet, Prakasam District,
ANDHRA PRADESH - 523 331.
ANDHRA PRADESH - 523 334.
Phone No.: (08596) 227338 / Mob: 09440026076
Phone No. : (08406) 237582 / 237625 / Mob: 09440510516,
Email: birdl234@rediffmail.com / birdl234@yahoo.com
Dr. Sarfaraz Ali Khan,
Ms. Sai Kumari,
L.V. Prasad Eye Institute,
Director,
Hyderabad Eye Institute,
Anuraag Human Services,
L.V. Prasad Marg, Banjara Hills,
Flat No. 202, II Floor, Ushodaya Enclave,
Hyderabad, ANDHRA PRADESH - 500 034.
27 & 28, Ushodaya Colony, Gudimalkapur,
Phone No. : (040) 23542790 / 23608262 /
Hyderabad, ANDHRA PRADESH - 500 028.
Phone No.: (040) 23561157 / 23560993 / 31030731 / 30612331 /30612822
Email: sarfaraz@lvpei.org
55201659 (R) / Mob: 09391008292
Mr. Vidya Sagar Oruganti,
Chief Functionary,
Rural Energy For Environment Development Society
(REEDS), 27 - 99, Gandhi Nagar, Yellamanchili,
Visakhapatnam, ANDHRA PRADESH-531 055.
Phone No.: (08931) 231293 / Mob: 09849946797
Email: orugantiyel@satyam.net.in
Fr. Jude Filbert,
Director,
Chittoor Multipurpose Social Service Society,
H. No. 4-1882 / 1, Durganagar Colony,
Chittoor District, ANDHRA PRADESH - 517 002.
Phone No.: (08572) 241372 / 09440539228
Email: cmsssl994@yahoo.co.in;
cmsss2003@sancharnet.in
LIST OF ACTIVE PARTNERS OF CBR FORUM
A ndhra Pradesh:___________ ________________________________
Mr. K. Chandrapaul,
Programme Coordinator,
Villages Improvement through Social Action (VISA), Central
School, Burakayalakota -517351,
Mulakalacheruvu Chittoor District,
ANDHRA PRADESH.
Phone No.: 08493 - 288 995 / 288 958/ 09440257784
Phone No. (08582) 251010 / Mob: 09440931865
09448029482, Email: caford@rediffmail.com
Email: visa99bkk@yahoo.com________________________
Mr. K. Nireekshana Rao,
Mr. S. P. Reddy,
SNEHA (Society for National Integration through Education
Executive Director,
and Humanizing Action), Sneha Campus, Bethavolu,
Uma Educational and Technical Society,
Gudivada, Krishna District,
Manovikas Nagar, (Behind)
ANDHRA PRADESH - 521 301.
Rayudupalem, Kakinada,
Phone No. : (08674) 246993 / Mob: 09440989714
ANDHRA PRADESH - 533 005.
Phone No. (0884) 2307097 / 2306039 /
Mobile: 09848164779
Email: umamanovikas@yahoo.com;
spreddy@umvk.org______________________
Mr. I. Srinivasa Rao,
Mr. Stephen Livera,
President,
Executive Director,
Chaitanya Jyothi Welfare Society,
Society for Development of Drought Prone Area,
26-11/1194, Thyagaraya Nagar,
H. No. 42- 189/1, Vengal Rao Colony,
Vedayapalem, Nellore,
Wanaparthy, ANDHRA PRADESH — 509 103.
ANDHRA PRADESH - 524 004.
Phone No. (08545) 234272 / 232305
Phone No.: (0861) 2344063 (O) / 2329013 (R) /
Mobile: 09885307263 ________________________________
Mr. Pilli Solomon,
CH. Raja Rao,
Executive Secretary,
Secretary,
Brethren Institute for Rural Development (BIRD), Prashanthi
Light for Blind, Opp. M. R. O’s Office,
Nilayam, Near M.P.D.O. Office,
Dornala, Prakasam District,
Valmiki Nagar, Bestavarapet, Prakasam District,
ANDHRA PRADESH - 523 331.
ANDHRA PRADESH - 523 334.
Phone No. : (08596) 227338 / Mob: 09440026076
Phone No.: (08406) 237582 / 237625 / Mob: 09440510516,
Email: birdl234@rediffmail.com / birdl234@yahoo.com
Dr. Sarfaraz Ali Khan,
Ms. Sai Kumari,
L.V. Prasad Eye Institute,
Director,
Hyderabad Eye Institute,
Anuraag Human Services,
L.V. Prasad Marg, Banjara Hills,
Flat No. 202, II Floor, Ushodaya Enclave,
Hyderabad, ANDHRA PRADESH - 500 034.
27 & 28, Ushodaya Colony, Gudimalkapur,
Phone No. : (040) 23542790 / 23608262 /
Hyderabad, ANDHRA PRADESH - 500 028.
Phone No.: (040) 23561157 / 23560993 / 31030731 / 30612331 /30612822
Emai 1: 5arfaraz@lvpei.org
55201659 (R) / Mob: 09391008292
Mr. G. R. Gowda,
Executive Director,
CAFORD,
Terubayalu, Madakasira, Anantapur District,
ANDHRA PRADESH -515 301.
Mr. Vidya Sagar Oruganti,
Chief Functionary,
Rural Energy For Environment Development Society
(REEDS), 27 - 99, Gandhi Nagar, Yellamanchili,
Visakhapatnam, ANDHRA PRADESH-531 055.
Phone No.: (08931) 231293 / Mob: 09849946797
Email: orugantiyel@satyam.net.in
Fr. Jude Filbert,
Director,
Chittoor Multipurpose Social Service Society,
H. No. 4-1882 / 1, Durganagar Colony,
Chittoor District, ANDHRA PRADESH - 517 002.
Phone No.: (08572) 241372 / 09440539228
Email: cmsssl994@yahoo.co.in;
cmsss2003@sancharnetm
Assam:_____
Mrs. Sayera Rehman,
Secretary,
Prerona,
Pratibandhi Sishu Bikash Kendra,
(Spastics Society of Jorhat),
Cinnamora, Jorhat, ASSAM - 785 008.
Phone No.: 0376 - 2360513 / 2361386
Email: preronal23@rediffmail.com
Ms. Suchismita Majumdar,
President, Swabalambi,
The Society for Rehabilitation and Training of Children with
Multiple Disabilities, Opp. Silpukhuri Post Office, Gandhi
Basti Road, Guwahati, ASSAM - 781 003,
Phone No. 0361-2663908 /9435190397
Email: swabalambi@sify.com
Bihar:__________________ __________
Mr. Ramdahin Sharma,
Secretary,
Gram Swarajya Sansthan,
Danapur Village, Bari Paithana P.O,
Islampur Via, Nalanda District,
BIHAR-801 303.
Phone No. : (06111) 257003/ 09934715328
Ms. Kranti Rashos,
Secretary,
Abhiyan,
Ram Krishna Colony,
Mahendru P.O, Patna, BIHAR - 800 006.
Phone No. : 0612 - 2311874/ 09431017405
Email: abhiyan_office@sify.com
Mr. Chandra Shewkar Azad,
Vikalp Foundation,
Chhotki Delha; Budhlal Bhagat Road,
(Gupta Jee House), R.S. Gaya P.O.,
Gaya District, BIHAR - 823 002.
Phone No. 0631-2215120
Sr. Ambrose Kadavelil, SSH,
Mediator for Disabled Persons,
Disability Development Centre
Sacred Heart Sister's Training School
C/o.Sacred Heart Convent, Banuchapra Village,
Bettaiah P.O, Post Box 14,
West Champaran District, BIHAR - 845 438.
Phone No. 06252-280247
Delhi:__________________________________
Fr. Susai Sebastian,
Director,
Chetanalaya,
9-10 Bhai Vir Singh Marg,
NEW DELHI- 110 001.
Phone No. : (011)23744308
Email: chetna@bol.mtnl.net.in
Ms. Vidhya Kalyani,
Namgyal Institute for Research on Ladakhi Art and Culture,
X - 14, Second Floor, Green Park,
NEW DELHI-110 016,
Phone No. 011-26855849
Email: nirlac@vsnl.net / vramasubban@yahoo.com
Sr. Anatsy,
Nirmal Jyothi,
Sector D, Pocket 3, Vasant Kunj,
NEW DELHI - 110 070.
Phone No. : (011)2689 6965
Email: sjcdelhi@hotmail.com / delhisjc@yahoo.com
Jharkhand:_______________________________
Mr. Kumar Ranjan,
Mr. Ram Narayan Mishra,
Secretary,
Gramin Navodaya Kendra,
Chetna Vikas,
Sisai,
Param Prakashanand Jha Path, Chhlatishi (Shivpuri),
Thana Road, Sisai,
T. Bilashi, Deoghar, JHARKHAND - 814 117.
Gumla, JHARKHAND - 835 224.
Phone No. : 06432 - 225045 (O) / 233091 (R) Phone No. 06524 - 256416 / 09431328194
/09431356255
Email: gnksisai@rediffmail.com
Email: chetna vikas@yahoomail.com
Mr. Ramlal Prasad,
Secretary,
Jan Sewa Parishad,
Head Post Office Road, Julu Park,
Hazaribad, JHARKHAND - 825 301.
Phone No. : (06546) 227246 / 09431140659
Email: parishad_jsp@yahoo.co.in
Mr. C. P. Yadav,
Secretary,
Lohardaga Gram Swarajya Sansthan,
Bank colony. Near Check Naka,
Lohardaga, JHARKHAND - 835 302.
Phone No. : (06526) 222386 / 224895 / 09431118156
Email: lgss@rediffmail.com / cpyadav@sify.com
Mr. Rajan Kumar,
Secretary,
Sinduartola Gramodaya Vikas
Vidyalaya, At. Siduartola, Morabado,
Ranchi, JHARKHAND - 834 008.
Mr. Birbal Prasad,
Secretary,
Manav Vikas,
At. Barwan, P.O. Ichak, Hazaribag District,
JHARKHAND -825 402.
Phone No. : (06548) 275273 / 09835133613
Email: mvichak_hzb@rediffmail.com
Md. Hashamat Rabbani,
Secretary,
Gram in Samaj Kalyan Vikas Manch,.
Shah Mohalla, Daltonganj,
Palamu District, JHARKAHND - 822 101.
Phone No. : (06562) 24458 / 09431159447
Email: gskvm@yahoo.com;rab786@rediffmail.com
Phone No. : (0651) 2542341 / 2552341
Email:
rajenranchi@hotmail.com
sgvvranchi@yahoo.co.in
Karnataka:__________________________________________
Fr. Mariappa Gregory,
Ms. Amali,
Director,
Secretary,
Bangalore Multipurpose Social Service Society,
Grameena Abyudaya Seva Samsthe,
Post Box - 4626, 5, Nandidurg Road,
IV Ward, Court Road, Doddaballapur,
Jayamahal Extension, Bangalore, KARNATAKA -560 046.
Bangalore Rural District,
Phone No. : (080) 23334962 / 23330437
KARNATAKA-561 203.
Phone No. : (080) 7670463 (0) / 7624096 (R) /
9342306009
Email: gass_97@indiatimes.com
Sr. Esther,
Sr. Maria Kripalini A.C.,
Nava Jeevana,
Animator,
Cluny Convent, Cantonment, Near O.P.D., Bellary,
Carmel Convent,
KARANATAKA - 583 104.
Nesargi, Bailhongal Taluk, Belgaum,
Phone No. : (08392) 242296
KARNATAKA-591 121.
Email: navajeevana@rediffmail.com
Phone No. : 08288 - 239121_______________________
Mr. Hari Das,
Sr. Leena D’Costa
The Association of People with Disability,
Seva Sadan,
No. 6, Hutchins Road,
Doddabelavangala P.O,
St. Thomas Town, Lingarajapuram,
Doddaballapur Taluk,
Bangalore, KARNATAKA - 560 084
Bangalore, KARNATAKA - 561 204.
Phone No. : (080) 25475165
Phone No. : (080) 7655373
Email: sesucsc@rediffmail.com ____________________
Mr. Vinod J,
Dr. (Mrs.) Saroja Ramachandran,
Project Director,
President,
Village Education and Development Society,
The National Association
Pavagada, Tumkur District, KARNATAKA - 561 202. for the Blind,
Phone No. : 08136 - 244232 / 244929 / Mobile:
NAB Rehabilitation Complex,
09448183712,247322
C.A. Site No. 4, NAB Road, Jeevan Bhima Nagar,
Bangalore, KARNATAKA - 560075.
Email: VEDS_PAV@hotmail.com
vedspavagada@hotmail.com
Phone No. 080-55374999 / 55374555
Email: nabk@vsnl.com
Rev. Fr. Vincent Fernandes,
Director,
Organization for the Development
Of People [ODP]
Bannimantap ‘B’ Layout,
Bangalore - Mysore Highway,
Mysore, KARNATAKA - 570 015.
Phone No. 0821 -2494195 /249838/ 2496176
Email: odpmysor@sancharnet.in
Sr. Reni Sabastian,
Nava Sanidhya,
Cluny Sisters, Centre for Integral Social Action,
Athani Road, Opp. Al-Ameen M.C. Hospital
Bijapur, Karnataka - 586 108.
Phone No. 08352-272120
Email: clunysisters@sancharnet.in
Rev. Fr. Peter Brank,
Director,
Chikamagalur Multipurpose Social Service Society
(CMSSS),
Seva Samsthe,
B. Katihalli, Arsikere Road,
Hassan, KARNATAKA - 573 201.
Phone No. 08172-241074 / 9448141075
Email: sevasam@sancharnet.in; Sevasam@yahoo.com
Fr. Ronald M. Varghese,
Punalur Social Service Society,
P. B. Bo. 50, Punalur, Kollam District,
KERALA-691 305.
Phone No.: (0475) 222191 / 225369 / 09447790192
Email: plrsociety@sancharnetin
Kerala:________________________________
Fr. Michael Vetticat,
Secretary,
Kottayam Social Service Society,
Thellakom (P.O), Kottayam,
KERALA - 686 016.
Phone No. : (0481) 2790947 / 48 / 49 / 951,
Sr. Grace Mary,
Nirmala Sadan,
Franciscan Clarist Congregation, Muvattupuzha P.O.,
Emakulam, KERALA - 686 661.
Phone No. : 0485 - 2833160 / 2834546 / 2831922 /
2832670/2836301
Fr. Joseph Mathew Oliakattil,
Director,
Center for Overall Development (COD),
P. O. Box No 33, Thamarassery,
Kozhikode District,
KERALA-673 573.
Phone No. : 0495-2223022 /09447084452
Emai; codtmsy@sify.com
Sr. Anies Mathew Nellikunnel,
Executive Director,
Jyothirgamaya,
College Road, Muvattupuzha,
KERALA-686 661.
Phone No. : 0485 - 2835570
Email: jyothirgamaya@rediff.com ;
Sr-anies-n@hotmail.com
Kerala:___________________________________
Mr. Josey Joseph,
Hon. General Secretary,
The National Association for the Blind,
Shalom Buildings, Archishop’s Campus,
Pattom Palace P.O., Trivandrum,
KERALA-695 004.
Phone No. (0471)2541595 / 2554218/2314267
Email: nabkeral@vsnl.com
Fr. Paul Moonjely,
Secretary,
Welfare Services Ernakulam,
Ponnurunni, Vyttila P.O. Kochi, KERALA - 682 019.
Phone No. : 0484 - 2344243 / 09422021475
Email: wse@vsnl.com
Fr. Kuriakose Nellattu,
Executive Director,
Samridhy Social Service Society,
Keezhillam, KERALA -683541
Phone No. : 0484 - 2652874
Email: samridhy@sify.com
Fr. Jose Kizhakkedath,
Malankara Social Service Society,
St. Mary’s Compound, Pattom P.O.,
Trivandrum, KERALA - 695 042.
Phone No. : 0471 - 2552892 / 09847160608
Email: tvm mssstvmi@sancharnet.in
Fr. Mathew Punakuiam,
Executive Director,
Bodhana, Thiruvalla Social Service Society,
Thiruvalla, Thukalassery, KERALA - 689 101.
Phone No. : 0469-2606063 / 2730561 / 9447130562
Email: bodhana.tsss@sify.com
Sr. Terence C.S.C,
Pratheeksha Bhavan,
Christ Nagar, Irinjalakuda,
KERALA-680 125.
Phone No. : (0488) 2825269 / 2805020 / 788978
Fr. Dr. Eldho Puthenkandathil,
Executive Director,
Shreyas Social Service Centre,
P.B.No.7, Suithan Bathery, Wayanad District,
KERALA - 673 592.
Phone No. : 0493 - 2620479, 222002/09447132002
Email: shreyassby@eth.net / info@shreyas.org_____
Fr. Shaj Kumar,
Director.
Neyyattinkara Integral Development Society,
Logos Pastoral Centre, Sanjose Nagar,
Neyyanttinkara, Trivandrum, KERALA-695121.
Phone No. : 0471 - 2220180, 2221545 /09847003362
Email: nids_nta@yahoo.com__________________
Fr. Jose Antony CMI,
Secretary,
Voluntary Organization For Social Action
And Rural Development (VOSARD),
Thekkady Junction, Kumily P.O.,
KERALA - 685 509.
Phone No. : (04869) 223850
Email: vosard@sify.com
Fr. Sebastian Thengumpallil,
Sneha Bhavan,
Gandhinagar P.O, Kottayam,
KERALA - 686 008.
Phone No. : (0481) 2597984 / 246993
Madhya Pradesh:_________________________
Mr. Shirshir Kumar,
Sr. Josetta,
President,
Seva Niketan,
Naman Sewa Samiti,
Cherikheri, Mandir Hasaud P.O., Raipur,
Vikas Nagar, Athner,
MADHYA PRADESH -492101.
Phone No. : (0771) 2471255 (R) / 2423995 (O) / Betul District, MADHYA PRADESH,
09826447052
Phone No. 07144 -286397 / 09425636770
Email: ngonaman@yahoo.com
Maharashtra^'
Mr. Shivlal Jadhav,
President and Trustee,
Bhatkya Vimukta Jati Shikshan Sanstha, House No. 4,
Sarvodaya colony, Mundhwa, Pune,
MAHARASHTRA-411 036.
Phone No. 020- 26872134, 27051189 / 09325500100
09372466612
Email: bvjss@hotmail.com_________________________
Mr. Deshmukh H.P.,
Yuva Gram,
“AKSHAY” Dharur Road,
Kaij, Kaij Taluk PO., Beed District,
MAHARASTRA-431123.
Phone No. -.02445-252134
Fr. Francis Dabre,
Commission for the Welfare of Disabled,
Bishop’s House, Barampur, Vasai Rd (W), Dist.
Thane, MAHARASHTRA - 401 202.
Phone Nos.: 0250 - 3469945
Manipur:_____________________________________
Mr. T. Peter Rangnamei,
Kh. Rajen Singh
Secretary,
President
Manipur North Economic Development Association,
Social Upliftment and Rural Education Manipur
Senapati Head Quarter, Behind PHED,
(SURE-MANIPUR), Khurai Sajor Leikai, Ukhrul
MANIPUR-795 016.
Road, P.O. Lamlong Bazar, Imphal,
Phone No. : (03878) 222728
MANIPUR-795 010,
Email: maneda@rediffmail.com
Phone No. 0385 - 2226570 /09436071942
(Joychandra)
Email: org sure@rediffmail.com;
suremanir@sancharnet.in
Kiran :09856138159,______________________
Mr. Md. Nizamudddin Shah,
Mr. K. Mharabi Singh,
Secretary,
United Voluntary Youth Council (UVYC),
Council for Anti Poverty Action and Rural Volunteers, Keisampat Modhu Bhawan, Imphal,
New Checkon (Didailong) Imphal East,
MANIPUR-795001,
MANIPUR-795001,
Phone No. 0385-2228774
Phone No. 0385-2227719_________________________
Mr. N. Gokul Chandra,
Agent for Social Change,
Kabo Leikai, Dewlahland, P.O,
Imphal-705001.
Phone: 0385-09436039429, Fax: 91-385-2400718,
email: asoc manipur@yahoo.com; n gokul@Yahoo.com
Meghalaya:
Ms. Sony Gill,
Secretary,
The Society for the Welfare of the Disabled,
Lady Veronica Lane, Laitumkhrah, Shillong,
Meghalaya-793 003.
PH: 0364-2210630 / 2210865, 9863026608
Email:
swd_ shillong@rediffmail.com;
sony christine@rediffmail.com
Orissa:_____________ ____________________
Smt Ranjita Dash,
Mr. Suresh Chandra Sahu,
Secretary,
President,
Lower Income People’s Involvement for Community Citizens Association for Rural Development
Action,
(CARD), Corporation Road, Berhampur,
Alok Nagar, Ambapua Engineering School,
Ganjam District, ORISSA - 760 001.
Berhampur, ORISSA - 760 010.
Phone No.: (0680) 2201069 /09437217584
Phone No.: (0680) 2290001 / 09437060001
Email: CARDGANJAM@hotmail.com
Email: lipica@sanchametin / lipica_bam@rediffmail.com
Mrs. Sneha Mishra,
Mr. Jagannath Mishra,
Secretary,
General Secretary,
Aaina,
Ekta,
N6-365, Jaydev Vihar,
1st Lane, Goutamnagar,
Bhubaneswar, Orissa - 751 015.
Koraput, ORISSA- 764 020.
Phone No. : 0674 - 3095040 / 09437017967
Phone No.: (06852) 250326
Email: aaina50@hotmail.com
Mr. Ashok Kumar Jena,
Secretary,
Institute for Self-Employment and Rural Development
(ISERD), At: Panda Pokhari, PO: Panaspada,
Via: Brahmagiri, Puri District, ORISSA - 752 Oil.
Phone No. : (06752) 241180/ 240974
Email: iserdpuri@rediffmail.com
Mr. Basanta Kumar Mishra,
Secretary,
Sri Nrusingha Dev Anchalika Yuba,
Parisad (SNDYAP), At Golasahi,
Khadipada P.O., Puri District, ORISSA - 752 002
Phone No.: (06752) 27219
Email: sndayp@yahoo.co.uk;
sndayp@vsnl.com
Rajasthan:
Smt. Mumtaz Ben,
Chairperson,
Mahila Mandal Barmer Agor,
Near New Power House, Opp. To Police Line,
Indira Colony, Barmer, RAJASTHAN - 344 001.
Phone No. : (02982) 221446, 260244, 225575 /
09414107446
Email: Adhilbhai4003@yahoo.com ; mmba@rediffmail.com _____________________________
Tatnilnadiv___________________________
Fr. V. Maria Arputham,
Bro. I. Sebastian, FSC.,
Diocese of Marthandam,
Executive Director,
9/41, Health for One Million,
St. Joseph’s Development Trust,
Kuzithurai, Kanyakumari District,
Genguvarpatti, Periyakulam Taluk,
TAMILNADU
- 629 165.
Theni District, TAMILNADU - 625 203.
Phone
No.
:
(04651)
260749
Phone No. : (04543) 264944 / 262366 / 263898
Email: sebaedsjdt@yahoo.com;
edsjdt@rediffmail.com______________________
Fr. A. Martin De Porrs,
Fr. Sengole,
Kumbakonam Multipurpose Social
Thanjavur Multipurpose Social Service Society,
Service Society,
2851 / 50, Trichy Road, P. B. No. 77, Thanjavur,
P. B. No. 3, Bishop’s House,
TAMILNADU-613 001.
Kumbakonam, Thanjavur District,
Phone No. : (04362) 2230977 Z09842590659
TAMILNADU-612 001.
Email: tajmsss@rediffmail.com
Phone No. : (0435) 2421386 / 24217754
/9443140614
Email: kmbsss@tr.dot.net.in____________________
Mr. S. Sankara Raman,
Fr. S. James Peter,
Secretary,
Lucia Society for the Blind and other Disabled,
Amar Seva Sangam, Post Box No. 001,
Silverpuram, Meetlavittan P.O., Thoothukudi,
Sulochana Gardens, 7-4-104B, Tenkasi Road,
TAMILNADU - 628 002.
Ayikudy Tirunelveli District,
Phone No.: (0461) 2345703 / 09842043457
TAMIL NADU-627 852.
Email: chrisen@sancharnet.in
Phone No. : (04633) 267170 / 2367160, 2367170
/09361011585
Mr. P. Titus,
Integrated Rural Community Development Society,
Plot No. 13, Dr. Abdul Kalam Street,
M. D. M. Nagar,, Tiruvallur,
TAMILNADU - 602 001.
Phone No.: 044-27660084 709444128803
Email: ircds@vsnl.com
Fr. A. T. S. Kennedy,
Secretary,__________
Email: amarseva@vsnl.com
Mr. A. Susainathan,
President,
Animators for Rural Multipurpose Development
Society (ARMDS),
2/52, Church Street, Mugaiyur Post,
Thirukovilur Taluk, TAMILNADU - 605 755.
Phone No. : 04513 - 237218 / 09443337218
/09443337310
Email: susainathans@yahoo.co.in
armds_org@yahoo.com ___________________ __
Fr. Rakchagar,
Pondicherry Multipurpose Social Service Society,
Coimbatore Multipurpose Social Service Society, Post Box Paul VI Development Centre,
No. 6, Bishop’s House, Coimbatore,
Archbishop’s House, 14, St. Therese Street,
TAMILNADU-641 001.
PONDICHERRY - 605 001.
Phone No.: (0422) 22391831 / Mob: 09443139152
Phone No.: (0413 ) 2332356 /9894052059
Email: cmsss@vsnl.com
Email: pmssspondy@hotmail.com
Mr. Leo Ambrose,
Anbu Ullangal,
Innovations,
147 Devarpuram Road,
Tuticorin,
TAMILNADU - 628 003
Phone No. 0461-2325191
Mr. Amitabh Mehrotra,
Project Director,
SPARC INDIA,
Guru Daya Niwas, 26, Sachivalaya
Mausambagh, Sitapur Road, Lucknow,
UTTAR PRADESH - 226 020.
Phone No. : ((0522) 2368608(0)
Uttar Pradesh:________________________________________
Ms. Sangeeta J. K,
Kiran Society,
Kiran Village, Kuruhuan P. O
colony, Post Box No. 5032, Madhopur,
Varanasi,
UTTAR PRADESH - 221 005.
Phone No.: (0542) 2670165 / 2670166 /
Emai 1:
rehabilitation@kiranvillage.org
sangeetajk@kiranvillage.org ;kiran_village@yahoo.co.uk
Sr. Jyothika,
Jeevan Jyoti,
Aktha, Sarnath P.O, Varanasi,
UTTAR PRADESH - 221007.
Phone No. : (0542) 2585151 / Mob: 09415221337
Email: jeevanjotischool@hotmail.com
jeevanjyoti_vns@sify.com
West Bengal:___________________________
Mr. Subhankar Golder,
Mr. Nazrul Islam,
Secretary,
Secretary,
Halderchak Chetana Society Welfare,
Indranarayanpur Nazrul Smiti Sangha (INSS),
P. O., Madhab Nagar,
P.O. Ramnagar Abad, South 24 Paragnas District,
South 24 Parganas Disk,
WEST BENGAL - 743 349.
WEST BENGAL - 743 374.
Phone No. : (033) 24300727 / 24108980 / 9830185170
Phone
No. : (03210) 260202
Email: inssngo@yahoo.com
Email: hccws@rediffmail.com
Sk. Mansur All,
Secretary
Graham Bell Centre for the Deaf,
Kamarpara, Pandua,
P.O.Pandua, Hooghly District,
WEST BENGAL-712 149.
Phone No. 03213-267529
Mr. Arun Kanti Naskar,
Secretary,
Prayasi Gram Bikash Kendra,
Gabberia Vill. P.O.,
South 24 Parganas District,
WEST BENGAL - 743 336.
Phone No. 03174-277146 / 94344 37132
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Advocacy in CBR of Persons with Disabilities
This paper has three sections. The first section is on ‘advocacy’, second on CBR of
persons with disabilities and the third is on portions of the Persons with Disabilities Act
and ways to advocate for the rights of persons with disabilities.
Section 1 — What is advocacy?
Advocacy is finding of public, legal space in which to systematically organize an action,
spiead awareness on public policy, lobby with and influence leaders and opinion makers.
The actions could be an attempt to
a) Shape public policy to advance social justice and human rights
b) Focus on inadequacy or discrimination in public policy or legislations
c) Enforce implementation of rights given by a policy or legislation
The public policies taken up for advocacy are often a specific issue, as for example,
women’s issue, rights of children, education and rights of persons with disabilities.
Advocacy involves
•
•
•
•
Resisting discrimination against a disadvantage group
Supporting and empowering the disadvantaged groups to ensure that larger leel
policies percolate to reality at the local and individual level
Accessing information and networking with other groups and individuals forming
coalitions to maximize the influence
Adopting a non-violent approach, within the public and legal framework, to
achieve the objective
Advocacy is not
•
•
A mere combination of various tactics and strategies; and
It is not a substitute for mobilization of the disadvantaged people and their
involvement or participation
Key elements in Advocacy
•
•
•
•
There should be a social cause, pertaining to a class of persons, a disadvantaged
or marginalized group
It requires the affected people to come together and work in cooperation. This
effort should be continuous and systematic
It is directed towards the establishment, for example, the government, the
government, the police, an authority practicing discrimination
It is aimed to bring about changes - change in public policy, change in people’s
attitudes, institutional structures, in laws, rules etc.
Benefits of Advocacy
• It builds confidence in the people engaged in action, in their ability to bring about
changes that matters to them
• It educates people on issues that affect their lives
• It takes the issues to a wider audience and helps change public policies, rules etc.
• It demands and enforces action on important issues
Advocacy involves gathering information and key actions
Collect data from the field to base the arguments on facts and figures
Get statistical information, such as the census, to know the population figures,
literacy rates, male/ female ration, education, family income and so on to project a
proper picture
• Scientific information, if available, from field and research reports, can be very
useful to argue the case
Personal stories can be used effectively to demonstrate what happens in practice.
It can be effective as it touches people’s emotions/ feelings
• The relevant laws, rules, policies and
• Reports from government and other authentic sources
•
•
Key strategies and action
• Spreading awareness in public and among leaders
• Media action - give information to public media
• Submit petitions, letters and memorandums to officials
• Lobbying with legislators and others, to raise the issue at a suitable forum
• Network and coalition with a wide variety of groups, organizations with whom a
common working understanding can be reached
• Demonstrations, protests, dhamas, etc.
• Filing Public Interest Litigation (PIL)
Advocacy is a pro-active, planned and co-ordinated action. With practices, one should be
able to anticipate events/ problems before they actually occur.
Contact and get as much support as possible from all sections for your cause Wider
grass root support can strengthen the argument. Put forward the case in a rational manner’
Do your homework. Develop credibility. Know your rights and laws.
Advocacy requires THINKING, but most of all ACTION.
Section - 2 - CBR - Definition by WHO, UNESCO and ILO is:
Community based rehabilitation is a strategy within community development for the
rehabilitation, equalization of opportunities and social integration of all people with
disabilities”.
CBR is implemented through the combined efforts of disabled people, their families and
communities, and the appropriate health, education, vocational and social services.
Through creating awareness, organizing and training in the community, CBR
programmes seek to empower the disabled and enhance their potential. It offers them the
same opportunities to attend school, receive vocational training and develop income
generating activities, across the available social and health services, to participate and be
an equal citizen in the community.
Section - 3 - CBR, Advocacy and the legislation for rights and protection on
persons with disabilities.
The Persons with Disabilities (Equal Opportunities, Protection of rights and Full
Participation) Act focuses on three aspects:
1. Rights of disabled persons, such as the right to education, rehabilitation
measures, concessions and benefits, training in vocational skills, employment,
social acceptance and equal opportunities.
2. Responsibilities of the government and the family towards the disabled
persons, such as providing opportunities to disabled persons to reach his/ her
full potential, through making use of opportunities provided.
Non-discrimination of persons with disabilities
In terms of rights of persons with disabilities, the PD Act specifies that
•
•
•
•
•
•
•
•
Scholarships and travel concessions: The government shall provide schemes for
benefits like maintenance allowance, scholarships, travel concessions etc.
Special schools and rehabilitation services: The availability of special schools,
rehabilitation and intervention services will be made available in all districts
Support to students: Books, learning aids etc., must be supplied in order to make
integrated education meaningful to the disabled child.
Ri^ht to education: The Act lays down that “The appropriate government and
local authorities shall ensure that every child with a disability has access to free
education in an appropriate environment till he (or she) attains the age of eighteen
years.”
The Act further provides that the government must provide schemes for part-time
classes for those who could not pursue education on a whole time basis, and
education through open schools etc.
Disabled persons’ right to access: The appropriate government shall prepare
schemes for accessible transport facilities and removal of architectural barriers in
schools, colleges and in other public places.
Disabled people have the rights to lead an independent life: Disabled children
have the right to vocational training to be able to learn a skill
Workshop for producing and repair and maintenance of aids and appliances have
to be set up, especially in rural areas.
•
•
•
Survey and collecting information: The Act provides that the government and
local authorities shall take measures like undertaking surveys on the causes of
disability, screening children for identifying ‘at-risk’ cases, sponsoring and
promoting awareness programmes, promoting health care through training staff at
primary health care units etc.
The Act provides for the prevention of disabilities, making the government
responsible to ensure that such schemes are implemented.
Disabled children have a right to be an active part of their community: In
furtherance of this, the Act provides that the government shall endeavour to
promote the integration of students with disabilities in regular schools. It also
states that necessary concessions must be made in school curriculums for disabled
children.
Responsibilities of the governments towards disabled person
The Act specifies that the government should make plans, programmes and
schemes for the welfare and betterment of life of PWDs. State level committees
have been constituted to plan such programmes and schemes. Five members from
NGO sector are represented in these committees
• One could ask if these committees meet regularly and ask the government to
make public the decisions of these meetings, as part of right to information. One
can also question when such decisions are not implemented.
• Commissioners have been appointed in all the states, whose responsibility is to
ensure that plans are implemented. Their job is to ensure that violation of the
rights of persons with disabilities and discriminations against them are prevented.
• NGOs can meet with the Commissioner and offer support to him/ her to ensure
the above.
•
Non-discrimination in the PD Act:
•
•
Provisions are made in the Act that no child or a person with disability is
discriminated only because of his or her disability. The affected person or the
NGO working in that area can bring such incidence to the notice of the State
Commissioner, who should look into the complaints and take remedial action.
The affected person, family or NGO working in that area should bring such
matters to the notice of the Commissioner/ concerned authority to take action and
to rectify the situation.
The National Trust for Welfare of persons with Autism, Cerebral Palsy, Mental
Retardation and Multiple Disabilities Act, 1999 provides for the setting up of a
Trust:
•
•
To strengthen facilities for the care and protection of persons with the four
specified disabilities
To evolve procedure for the appointment of guardians and trustees for persons
with disabilities requiring such protection.
(Please read the full Act for more details)
Action on these accordingly, should be taken at three levels • Individual and family
• Community/ society
• Governmental/ Political level
At Individual level, and through NGOs, we can create awareness on the
provisions and rights under the Act. We cannot remain passive and expect the
government to take responsibility and act in favour of disabled people
• At family level. The responsibility of the parents to ensure that their child
with disability is given proper care and trained in activities of daily living, so
that he/ she can grow up to live an independent life
• Each one of us can put in some effort at home, school, in public and at work
place in small but significant ways to help in this. For example, a school
teacher can ensure that children with disability are enabled to attend class, and
included in regular activities of the school and games etc.
• In rural areas where disabled persons have no special facility, where resources
are limited, admitting disabled children into school itself is a big thing. By
being with other children, he/she will feel encouraged and accepted. Children
who are not so severely disabled should be integrated in to regular schools.
• In our work place, office, factory or institution, we can ensure that disabled
people are given jobs. We can persuade our friends to do so as well.
• At community/ society level, creating awareness on disability is important.
Giving positive image of persons with disabilities through writing slogans on
walls, street plays, songs and other visual aids are also helpful.
• The PWD Act has been summarized in an easily understandable language and
been translated into regional languages. NGOs can publish this widely.
• At the government/ political level, influencing and advocating with the
planners to include project and schemes for disabled persons is an important
step. At present this is not being done by many organizations. Unless there is
pressure on the government, it will not act. Individuals and organizations in all
the states can come together to gain enough political strength.
•
Need to communicate and network
Raising awareness is only the first step to bring about a change. However, just
raising awareness will not bring about a change. The system should also be made
to provide opportunities for disabled people to benefit from them. For this, we
need to work at different levels. Networking among NGOs is a positive way to do
In Bangalore, four years ago, several NGOs working with disabled people,
parents of children with disabilities, their advocates and other concerned citizens
foimed a coalition called ‘Disability Network’. It works to raise awareness among
NGOs and general public on disability issues, acts as a forum for discussion and
takes up issues with the concerned authorities regarding the provisions of the Act
Matters concerning issue of ID Cards, travel concession, school examination
system, access in public places, benefits and facilities and other issues have been
taken up successfully with the government through this Network.
In Andhra, Tamil Nadu and other states too similar networks have been formed. It
is important that disabled people and NGOs come together to build a strong
movement. There is an urgent need for advocacy and lobbying with the concerned
authorities for the protection of rights, providing equal opportunities and enable
full participation as provided in the two Acts. This can happen only when all
concerned join together and act.
SCABIES
Scabies is a common, highly infectious disease of the skin, caused by the scabies
mite. It is mainly seen in children, but can also affect adults.
Cause :
A small insect called the scabies mite, which can just be seen by the naked eye.
Scabies is not spread by dirty water.
Symptoms and signs :
1. Small swellings all over the body, but more common
• between the fingers,
• on the wrists,
• around the waist,
• in the groin,
• on the buttocks (especially in children),
• below the breasts.
2. Itching which is worse at night.
3. Sores with pus - due to scratching and through infected clothing.
How is it spread ?
It is spread through close body contact and through infected clothing.
Treatment:
Important points to remember :
(a)
•
•
(b)
Treat all members of the family or household at the same time.
Ointment or lotion to be applied correctly over the whole body below the
chin.
Medicines for scabies :
1. Gamma benzene hexachloride (GBH) - 1% cream, ointment or lotion.
Most effective, needs one application only. Do not use in children below one
year of age and in pregnant and breast-feeding women.
2. Benzyl benzoate - 25% lotion - effective, but needs two applications. To be
used diluted 1:3 in children below one year, and 1:1 in older children.
3. Neem and haldi paste - Grind neem leaves with turmeric and apply to the
whole body after a bath. Repeat the applications for another two days,
without bathing. A bath may be taken on the fourth day.
1
(c)
Application of cream or lotion:
1. GBH 1% cream or lotion - After a bath in the evening, applies to the whole
body below the chin, applying more on the affected areas, eg. between the
fingers. Let it remain overnight for 12 to 24 hours, and then a bath may be
taken.
2. Benzyl benzoate 25% lotion -
(d)
1st day evening
Bath.
Apply lotion to whole body below chin.
2nd day
No bath.
Apply lotion again as above.
3rd day
Bathe and wear fresh clothes.
In case of infected scabies (with sores and pus), the infection should be
treated first before treating the scabies.
Give co - trimoxazole to the patient for at least five days.
Gentian violet 0.5% solution may be applied once daily on sores.
After sores heal, use one of the above lotions or creams.
Itching may continue for 2-3 weeks after treatment. Explain this to the patient,
and give chlorpheniramine maleate tablets twice a day.
(e)
Other measures:
Keep all clothes (including bedding) out in the sun for 4 to 6 hours to kill the
scabies mites living in them.
Prevention of scabies :
Good personal hygiene
bathing daily.
Changing clothes daily.
Washing clothes regularly.
April 2005.
Dr. Ravi D'Souza,
M.D. (Community Medicine)
2
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XXXIII MFC ANNUAL MEET
Public Health Education in India: Lacunae, Challenges & the Way Ahead
Programme
DAY 1 (28,h Dec.)
Session 1
9.30- 1.30
10.30- 11.00 Tea Break
History of Public Health Education (PHE)
(prefacing the discussion with paper highlights)
a. Public Health Education in India: A Historical Review
b. Development of PHE in Other Countries: A Comparison
c. Public Health and the NGO Sector
d. A Counter-Culture View of PH in India
Chair: Anant Phadke
Summarising the issues: Ritu Priya
1.30-2.30 LUNCH
Session 2
2.30- 5.30
3.30- 4.00 Tea Break
Public Health Education - Institutional Experiences
SIHFW
X Primary and Paramedic Worker Training
Community Health Cell
d, CEHAT
PSM departments
f. CHAD, Vellore
g. Achyuta Menon Centre,
h. CSMCH, JNU
Chair: Veena Shatrugana
Summarising the issues: Renu Khanna
DAY2(29,h Dec.)
Session 3
9.00-1.30
10.30-11.00 Tea Break
Towards an MFC Perspective on PHE: Democratisation & Public Health
a. Cross-cutting Issues of Structure, Content & Learning Methods
b. Multiple Frameworks
• PHE Needs as Seen From the Grass-roots
• Public Health Foundation India
• Reforming Medical Education & Health Service Systems
• Public Health Movement
Chair: Chinu Srinivasan
Summarizing the issues: Alpana Sagar
12.30-1.30 Group Dis<cussion (4 groups)
a.
b.
SX?
phEph perspea“
Content of PHE
c.
Teaching/Learning Methods
Regulation & Monitoring of PHE
d.
I
1.30-2.30 LUNCH
2.30-3.00 Group discussion contd.
Session 4
The Way Ahead
k Strategies, Commitments
3.00-4.00
Group Reporting in Plenary
Summary of issues: Rakhal Gaitonde
4.00-5.30
a.
b.
Gathering the Threads, and Outline
of What We Feel Should be Done
Towards Actualising the Plan
Specifying Commitments
Facilitators: Thelma Narayan & Ritu Priya
Please Note:
Annua|9GSenSera?SBodyPX?ng^^
be held post-dinner.
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Hope
When the Darkness of the light will recede
When the morning glow will flow
When the dream will come true
When the heart will beat with joy
That day shell
When no one will weep helpless
When no one will sleep hungry
When all will have roof above
When al will have content heart
When people will not die
On foot path of the cities
When the alms will not be kept
On the palm of the workers
When every laboring hand
Will enjoy right full share
That will come
When operation will not be tolerated
When the home will not be burnt down
When the blood will not be flow on the street.
When the eyes
Will not be filled with pan
That day shell come
When in the name of religion
People will not be taught hatred
When this earth will be
Sprinkled with colorful petals of love
When the rays of peace will
Light the world
That day shell come
That day shell come
Javed Akhtar
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