A look at community-based rehabilitation

COMMUNITY-BASED rehabilitation is a strategy for public development that seeks to enhance the well-being of persons with disabilities.

The practice was started by the World health Organisation following the 1978 Alma-Ata Declaration, whose objective was to enhance the quality of life of persons with disabilities and their families.

This was to be done through meeting their basic needs and ensuring their inclusion and participation at grassroots level in resource- constrained settings.

When Zimbabwe attained independence in 1980, the country was quick to adopt a stance that focuses on primary healthcare and community-based rehabilitation.

This was aimed at ensuring access to healthcare and social services by all — including black people living in rural areas. Individuals with disabilities were also covered.

During the colonial era, healthcare facilities were largely concentrated in urban areas, and so were medical professionals and assistants.

This was to the detriment of the majority of black people, including those with disabilities, who lived in rural areas.

however, there was a shift in 1982, when the concept of community-based rehabilitation was adopted.

Later evaluations of the programme revealed improved service provision to persons with disabilities and their families, including at the grassroots level in rural areas.

Regarding assistive devices, a robust referral system — from the grassroots level to specialist services at district healthcare facilities and beyond — has been noted in a context in which service provision is strengthened by village health workers.

They are working under the Ministry of health and Child Care; and the Ministry of Public Service, Labour and Social Welfare.

Village health workers are a strong link between community members, who include persons with disabilities, and the formal healthcare delivery system.

The duties of the workers include health promotion and education; disease surveillance and reporting; screening; referral of patients to the nearest healthcare facility; and treatment of minor ailments such as flu and diarrhoea.

The needs and concerns of persons with disabilities, including children and youths with disabilities, are given attention.

Conversely, the primary duties of community care workers include identification of cases and referring them to child welfare officers; promotion of child rights through awareness raising in the community; accompanying children, parents and guardians to access services; following up on cases; maintaining up-to-date information on children in the community; preventing and responding to abuse; and addressing harmful traditional practices such as child marriages.

Likewise, they pay attention to the needs and concerns of persons with disabilities, including children and youths with disabilities.

This means village health worker and community care worker programmes have, among other things, adopted a strong disability lens.

They cater for the needs and concerns of persons with disabilities, including those in remote rural communities.

Village health workers and community care workers are closer to the people, including persons with disabilities, and they work collaboratively to enhance the health and well-being of the targeted beneficiaries.

The local community-based rehabilitation programme takes a multi-sectoral approach to improving the equalisation of opportunities and social inclusion of persons with disabilities.

In this context, the community-based rehabilitation programme is taking a Government-society approach to cater for the needs of persons with disabilities from birth and beyond.

A key feature of community-based rehabilitation is community participation through programmes that are designed to place persons with disabilities at the centre.

It is not surprising that in Zimbabwe, community-based rehabilitation is implemented through the combined efforts of persons with disabilities themselves, their families and communities, as well as relevant State and non-governmental organisations.

Such stakeholders work in diverse thematic areas, guided by the World health Organisation’s community-based rehabilitation matrix, which has five pillars — health, education, livelihoods, social aspect and empowerment.

According to the United Nations Convention on the Rights of Persons with Disabilities, comprehensive rehabilitation services focusing on health, employment, education, social services and empowerment are needed to enable persons with disabilities — including children with disabilities — to attain and maintain maximum independence; full physical, mental, social and vocational ability; and full inclusion and participation in all aspects of life.

Community-based rehabilitation extends health and social services to isolated remote rural areas. Let us all join hands in strengthening the community-based rehabilitation programme in our country.

◆ Dr Christine Peta is a disability, policy, international development and research expert. She is the national director of disability affairs in Zimbabwe. She can be contacted on: cpeta@zimdisabilityaffairs.org