1. Implementing Rehabilitation Programmes: Briefing to the Joint Monitoring Committee on Improvement of quality of life and status of Children, Youth and Disabled Persons. Sandhya A Singh Director: Chronic Diseases, Disabilities and Geriatrics Department of Health 30 May 2008

2. Introduction  Access to health care creates equalization of opportunities.  Comprises various components including rehabilitation.  Prevention is integral – all levels  Rights-based service delivery  Barriers experienced are noted  Persons with Disabilities are within health system  Implement policy to improve quality of lives.

3. The outline of the presentation..  Underlying policy  Policy must benefit those in greatest need  Disability and rehabilitation exclusion  Comprehensive rehabilitation service  DOH creating access to rehabilitation services  Barriers are noted  Conclusion

4. Legislation and Policy underlying service delivery…  National Context  National Health Act (No 61 of 2003)  Mental Health Care Act (No 17 of 2002)  National Rehabilitation Policy  Free Health Care Disabled People at Facility Level.  Child Youth and Adolescent Mental Health Care Policy Guidelines.  INDS (1997)

5. International Context….  U N Convention on the Rights of Persons with Disabilities  Translate into the proposed National Disability Policy Framework  Articles  Cross Cutting eg Prevention, Access to Information  Health, Rehabilitation and Habilitation.

6. Policy must access those in greatest need….  DOH recognizes a rights-based definition  Supports the Cabinet proposal (1995)  Disability is the loss of opportunity due to barriers  Compliant with the ICF  2001 Census – “Reported impairment”  Impairment based  How do we measure barriers?

7. In attempting to benefit those in need…..  Disability results in further Exclusion …  Poverty  Difficulty accessing basic services in general.  Difficulty accessing rehabilitation  Vulnerable to disease  Women  Mothers or caregivers  With disabilities  Low levels of literacy

8. Comprehensive Rehabilitation……  Various levels of prevention  Goal-orientated  Time limited process  Enable person to reach optimal functioning  Social integration

9. CBR is a Philosophy first…  Based on CBR as a Philosophy  Person with Disability/Family and/or Caregiver is central to all decision making processes  Rehabilitation occurs “with” and not “for”  NDPF recommends the development of inter sectoral policy on CBR

10. What comprehensive rehabilitation includes….?  Primary Prevention  General Public  Information must be in an accessible mode and format  Healthy lifestyles  Prevent Onset  Secondary Prevention  Early Identification and Intervention  Referral sytems  ECD  Inter Sectoral Collaboration

11. Comprehensive rehabilitation….  Tertiary prevention – Rehabilitation  Inter sectoral and Multi-Disciplinary  All levels of care  Provision of Assistive Devices,Technology,Surgery  Provinces vary in terms of their capacity to issue  Eg – November 2007 Gauteng 1717 manual wheelchairs Eastern Cape 1453 wheelchairs

12. Changing profile observed…  Increasing demand from persons with acquired impairment and disabilities  HIV and AIDS  Neuro-anatomical,sensory  Diseases of lifestyle  Stroke  Diabetes related Amputations Blindness

13. DOH creating access to rehabilitation toward improving quality of life…..  DOH Strategic Plan 2008/09-2010/11  Free Health Care at Facility level  Accessibility of health facilities  Physical  Communication  Access – point of public transport to facility  Waiting period for wheelchairs  Policy  Orientation and Mobility Services

14. Creating Access…..  Intra Sectoral Collaboration eg:  MCWH  Foetal Alcohol Syndrome  Care and Support  Step down Facilities  Geriatrics  Rehabilitation @ old age homes  Facilities Planning  Building accessibility

15. Access …..  Inter Sectoral Collaboration  DOE  Collaboration on implementing WP 6  ECD  DOSD  Disability Grant Assessment  ECD  RAF  Propose that assessment tool for serious injury is based on the concept of ICF – impact of injury

16. Access…..  Information/ Education  SABC/ local radio education programmes  Basic sign language and interpretation training for health service providers  Provinces exploring training of Deaf persons as VCT counselors  Making HIV &AIDS education accessible to all.  Community Service for therapists  Access to services by many communities for the first time.

17. Access….  Economic Development  Persons with Disabilities to repair wheelchairs  Located at wheelchair repair sites  Receive remuneration in various forms SLAs with NGOs Paid directly

18. When there are barriers to access…  Within the health system  Services at a local level?  Lack of or limited resources  Recruitment & retention of Therapists  Transport to reach patients in the community  Budget Assistive Devices/ Other technology Consumables – Nappies, linen savers

19. Barriers…  When resources exist..  Limited space available  Provincial budget system  Centralized vs decentralized  Difficulty to sustain  NGO initiated – integrate into the health system  “priority” competing with other programees  Difficulty to apply systems to rehabilitation – seen as something different outside health

20. Barriers…experienced by the person  No support/assistance  Children  Adults and older persons who are not independently mobile.  Public Transport  Cost  Basic availability  Models of service delivery are inappropriate  “do for”  CBR – common Understanding???

21. Thank You. Sandhya Singh SinghS@health.gov.za Cell 0828825012 Tel (w) 012 312 0472/3

22. In conclusion….  Rehabilitation often provided under very difficult circumstances  Rural doesn’t mean poor quality  Commitment by service providers must be recognized.  HOWEVER!  Recognize GAPS!  Accessibility to rehabilitation by all communities-EQUITY Assistive Devices/technology  Reinforcing Human Rights approaches  Strive to create optimal environment  We must work together.