Optimising Rehabilitation post structures: Strengthening the District Health System GUBELA MJI Centre for Rehabilitation Studies Stellenbosch University 10 August 2011

Format of the presentation Disability and Rehabilitation definitions Policies and instruments underpinning rehabilitation Challenges with district health rehabilitation Strengthening rehabilitation in the District Health System

Definition of terms: Disability An umbrella term for impairments, activity limitation and participation restrictions. It donates the negative aspects of the interaction between an individual (with health condition) and the individual contextual factors (environmental and personal factors. (WHO – ICF, 2001)

The voices of disabled people “In our view it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society (Oliver 2004:19)” Disability: A human rights and development construct

Definition of terms: Rehabilitation Goal oriented Time limited Enabling optimum mental, physical and social functional level. Provide tools to adapt and change ones life – Rehabilitation is an agent of/for change. Rehabilitation: Requires to asset herself as a science within the health science Faculties and a human rights and development agent.

Helanders operational definition Helander argues that rehabilitation not only includes the training of disabled people but also interventions at a society level (elimination of physical and attitudinal barriers), equalization of opportunities, adaptation of environment and promotion and protection of human rights (WHO, 1992)

Policies and instruments underpinning rehabilitation National Rehabilitation Policy: Social policy Integrated National Disability Strategy: Plans for Revision UN Standard Rules For Equalization of Opportunities for Disabled People UN Convention For Persons with Disabilities Health and other government developmental Policies CBR Guidelines

CBR a Principle that underpins the NRP CBR is an approach to delivering services to the population, and not a service itself. It is not “what” we do, but “how” we do it (Dept of Health, 2000).

Barrier-free environments WHO-DAR 2004 views on CBR Empowerment Barrier-free environments

Challenges with district health rehabilitation Training that does not fully address SA needs Link between poverty, disability and vulnerability factors overlooked Profession specific models versus needs based and health promotion and prevention models The use of the deficit models versus asset model Identification of collaborators Epidemiological research Link between policy and Practice Advocacy and lobbying seen as messy Overlooking working within a human rights based approach.

Strengthening rehabilitation in the District Health System Training should change and focus: On a curricula that address SA needs A rights based approach On health promotion and prevention of disease On an asset models Need to evaluate existing Rehabilitation models There is a need to engage on a discussion involving all stake holders regarding how to implement a rights based rehabilitation services in South Africa. There is a need to learn from grass root CBR and DPO initiatives that are already existing.

Key focus areas A Human resource plan for development A professional strategy with a social construct An educational strategy that creates clear rehabilitation identity A need to develop an integrated disability and rehabilitation strategy Revisit the human rights and social approach specified in our policy Be strategic: CBR approach