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

2. 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

3. 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)

4. 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

5. 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.

6. 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)

7. 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

8. 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).

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

10. 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.

11. 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.

12. 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