Documente Academic
Documente Profesional
Documente Cultură
of
Persons with Disabilities
THE DIFFERENT PERSON
Formerly
Coordinator
Disability Research and
Training, ActionAid India
JAYPEE BROTHERS
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© 2006, S Pruthvish
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system,
or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and author will not
be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be
settled under Delhi jurisdiction only.
First Edition: 2006
ISBN 81-8061-609-6
and to enlarge my vision to include Chronic Care, I am grateful to MSRMC for giving me
opportunity to place the agenda of CBR in the field practice area of MS Ramaiah Medical
College, Bangalore. I am especially indebted to Dr T. Hemanth, Dr Ravish, Dr M. Dayanand,
Dr Mrs. Renuka Prithviraj who stood with me and continuing to do so. Experience at
Kaiwara augured my enthusiasm to devote time and energy to pool my experiences.
Mr NSN Murthy, Associate Professor, Statistics, Department of Community Medicine,
MSRMC has been of lot of support to initiate the CBR endeavor in Kaiwara PHC area.
I am grateful to my wife Jyothi, children Sindhu and Sachin, and my mother for tolerating
my non-availability to them adequately during the preparation of this work. Jyothi helped
me write/edit suggest changes throughout. It was a great support for me for the book
to reach this stage. It would have not been possible to contemplate without her patience,
respect and love for me.
I am thankful to Ms. Soumya Gaurav, student of Physiotherapy in MS Ramaiah Medical
College who carried the message of CBR to students of Physiotherapy in Kempegowda
Institute of Physiotherapy and who is remotely responsible for making me work on this
book. She responded to my calls to learn about CBR while she was an undergraduate
student.
I immensely thank the Chairman and Managing Director of Jaypee Brothers Medical
Publishers, Shri JP Vij for making this book available to students of Physiotherapy. I am
confident that this will help the students to develop a perspective towards CBR approach
in their work and will enable them to develop compassion and will make lives of persons
with disability easier.
I am thankful to Anil, Theju, Vanditha and team for the preparation of drafts.
Preface
Community Based Rehabilitation (CBR) for, of and by persons with disabilities is proposed
by world bodies like World Health Organization as a cost-effective approach towards
rehabilitation. The joint statement of WHO, ILO, UNESCO clearly delineates concepts and
principles of CBR.
Physiotherapists constitute a major human resource, which is yet to be tapped for CBR
optimally. There is need to bring in the approach of CBR in every facet of their work. Then
only it will be possible to reach 2.13 percent of the population of India who are disabled,
about 74 percent of them living mostly in villages and slums, according to Census of India
2001. It is a good step that Health Universities in India have a subject in CBR for students
of Physiotherapy. While it will be possible to introduce CBR through this way, more will
be gained if attempts are made by Physiotherapy Colleges and teachers of Physiotherapy
to develop demonstration projects in the proximity of their institutions. This will help making
learning of CBR easier, more meaningful and useful to students. Indeed, I feel that teaching
of CBR should be reflected in all aspects dealt with in the entire curriculum of Physiotherapy
course. CBR provides an opportunity for institutions and teachers of Physiotherapy to
be role models and express their social accountability in teaching, research and service
and empowerment areas of their work.
The book is designed to meet the requirements of undergraduate students of
Physiotherapy of Indian Universities and I understand it is a maiden attempt in the
developing world. I request the faculty and students to help me with their critical comments
and suggestions to improve this first edition.
Meeting the syllabus of Indian Universities for undergraduate students in CBR, it
addresses to cover areas of History of Rehabilitation, Disability – definition and
classification, Disability Identification, Disability Prevention, Early Identification and Early
Intervention, Concepts, Principles and Components of Community Based Rehabilitation,
Planning and Implementation of CBR, Supervision, Monitoring and Evaluation of CBR,
Resources for CBR and Disability Rehabilitation, Legislations, Aspects of Vocational Training
and Employment, Role of Physiotherapists in CBR. Assignments and practical learning
exercises in CBR are also suggested.
With useful case studies and illustrations, it is hoped that the book will sensitize the
students and faculty of Physiotherapy to adopt CBR approach in their work.
The book will be useful for students of Medicine and Nursing to gain more knowledge
about Community Based Rehabilitation. Many of my friends feel its usefulness for NGO
sector too – for implementation.
VIII COMMUNITY BASED REHABILITATION OF PERSONS WITH DISABILITIES
SUGGESTED METHODOLOGY
• Lecture/discussion: Arranging oration by eminent people who have worked for disability
issues.
• Watching the films: My Left Foot/Koshish/Heidi/Beautiful Mind.
PRE/POST EVALUATION
• List disabled people from Epics/History
• How disabled people’s needs were addressed in the past?
• List important milestones of development.
HISTORY OF REHABILITATION
In Mahabharath, renowned emperor of Hasthinapura, Dhritharashtra was blind. Shakuni
was lame. In Hindu purana—Aruna, the Sarathi (driver) of Sun God was deprived of both
his limbs, but was the fastest driver of the chariot of Sun God.
2 Community Based Rehabilitation of Persons with Disabilities
In ancient times hardly any one helped the handicapped. The welfare of the group
depended on the ability of each member to fight and to work. Handicapped people who
could not fulfill their responsibilities threatened the safety of all and many were driven
away and left to die. Most ancient people believed that evil spirits caused injury or disease,
the spratans let deformed children die of exposure. In Rome, its parents could legally drown
a disfigured infant.
During the middle ages, from about the AD 400 to the late 1400 people ridiculed the
handicapped and regarded them with suspicion. Some nobles used Physically Handicapped
as Jesters. Many handicapped people were burned as witches. Attitude towards handicapped
began to change during 1800s. Many people began to pity the disabled and treated them
with special care. Nevertheless individuals with handicaps were brought to bring shame
on themselves and their families. As a result most handicapped people were kept hidden
away at home or in special institutions.
his epic masterpiece “Paradise Lost”. The great German composer Beethoven wrote much of
his finest music after he became deaf. Franklin D Roosevelt, paralyzed in both legs by Polio
at the age of 39 years, became President of United States. The American Helen Keller became
blind, deaf and mute before she was two-year-old, but she learnt to read, write and speak.
She devoted her life to helping the deaf and the blind. Christ Brown, an Irish author and poet,
was born with cerebral palsy. He taught himself to write with his left foot. His autobiography
‘My Left Foot’ was published in 1954 and has been made into a film.
Thaimur Khan, who was lame, was a great warrior who conquered most of the world.
Louis Braille developed communication for blind through Braille script.
Panchakshari Gavai, hindustani vocalist, ran a boarding school to teach music to poor
and blind children. Puttaraja Gavai—his disciple following the suit. Mrs. D. Suryaprabha
is a famous violinist in Bangalore. The young Maruthi Prasad of Sri Ramana Maharishi
Academy for the blind sings very well and surprises everyone.
CN Janaki, whose both limbs are paralysed due to poliomyelitis in childhood, learnt
swimming after she was thirty and swam the English Channel. Many blind students of Sri
Ramana Maharshi Academy for Blind have learnt Bharath Natyam with enthusiasm and
determination and have performed the world over.
Stephen Hawking, the Noble laureate who is stuck to wheelchair, has made difference
in the area of Physics.
Sudha Chandran, who lost her limb in an accident dances with artificial limb and is a
famous actress too.
Special education: Is instruction designed to help persons/children with disabilities use their full
learning ability. It includes instruction in class room, at home and in hospitals and specialized institutions.
Teaching disabled children requires special skills and materials. A specially trained teacher may be
needed to teach children with mental retardation to care for themselves and to teach them basic school
syllabus.
The World Book Encyclopaedia (International) 1992.
Vocational Training: Partially sighted children may require books with large print. Blind children learn
through braille books and talking books (recordings on records/tapes). Computer aided voice synthesisers
have made difference to person with visual disabilities.
Vocational training prepares persons with disabilities to hold a job.
The World Book Encyclopaedia (International) 1992.
Community-based Rehabilitation
In 1979, at Alma Ata, Russia—when primary health care was mooted by WHO, community-
based rehabilitation was proposed as an attempt/approach for rehabilitation. In community-
based rehabilitation, focus is on rehabilitation process as part of development process, with
focus on skill transfer from professionals to families, disabled persons and community
volunteers; appropriate technology using the locally available resources. We see attempts
in this direction in India by many agencies like ActionAid India, Christoffel Blinden Mission,
District Rehabilitation Scheme of government of India and umpteen number of small-scale
efforts by many NGOs in the country. Grameena Punarvasa Yojana and National Programme
for the Rehabilitation of Persons with Disabilities (NPRPD) are attempts by government
of India towards community-based rehabilitation since last 3 years.
Rehabilitation Medicine
Is a branch of medicine that helps improve the condition of disabled people. In most cases, rehabilitation
is carried out by a hospital by a team of specialists headed by a physician. The specialist may include
nurses, psychologists, social workers, speech therapists and various others.
Contd...
History of Rehabilitation of Persons with Disability 5
Contd...
Many people with disability are helped by physiotherapy which involves treatment by heat / light / water.
It may include special exercises that restore patient’s endurance and muscle strength.
The World Book Encyclopaedia (International) 1992.
Occupational Therapy
Helps overcome / reduce handicaps by teaching patients various skills. E.g. A person who has lost
both legs may learn how to drive a specially equipped car.
The World Book Encyclopaedia (International) 1992.
Prejudice to Dignity
Another important milestone in the history of rehabilitation is growing realization for
empowerment of people with disabilities, protection of their rights, equal access and
opportunities and their integration into the mainstream as important attempts towards
rehabilitation. Towards this end we see the formulation of UN Standard Rules by United
Nations, enactment of disability legislations across the globe and India being a signatory—
we see the enactment of Disability Act of 1995 in our country. Empowerment approach,
organization of disabled people and working for community-based rehabilitation through
organized groups of disabled people, community-based groups, parent’s groups is being
attempted. Efforts of action on disability and development, an organization based in UK
with operations in India and many developing countries, e.g. Pakistan, Afghanistan,
Bangladesh is laudable.
The symbol of ‘Wheelchair’: Is often need to indicate area reserved for persons with disability. It may
be toilet, it may be car parking, it may be a seat in a bus/train. It may be vehicle being driven by a
person with disability.
BIBLIOGRAPHY
1. Bharatheeya Vidyabhavan “Mahabharath”, Bharatheeya Vidyabhavan.
2. Einar Helander “Prejudice and Dignity” UNDP.
3. Peter Coleridge “Disability, Liberation and Development” OXFAM.
4. R S Pandey, Bhushan Punani (1993) “Perspectives in Disability and Rehabilitation” Disability Division, Action-
Aid India, Bangalore, India.
Disability: Definition
2 and Classification
LEARNING OBJECTIVES
At the end of the session, the participants should be able to:
1. Explain differences between impairment, disability and handicap.
2. Understand and appreciate magnitude of problem of disability in the country.
3. List major causes of disabilities. List major types of disabilities.
4. Appreciate the need for integration of disabled people into the main stream of the society
as well integration of services for disabled people.
OUTLINE OF CONTENT
• Definitions and explanation of impairment, disability and handicap.
• Magnitude of the problem of disability—evidence base from different sources.
• Causes of disabilities
• Types/classification of disabilities.
• Excerpts from the book Disability, Liberation and Development by Peter Coleridge.
SUGGESTED METHODOLOGY
Lecture—Discussion
PRE/POST EVALUATION
• How many people with disability may be found in a village of 1000 population?
• What are common types of disabilities?
• What are major causes for disabilities?
from impairment) of ability to perform an activity in the manner or within the range
considered normal for a human being.
Because of disability, the person experiences certain disadvantages in day to day living;
is unable to fulfill the obligations required of him and play the role expected of him in
society. A handicap is a disadvantage for a given individual, resulting in an impairment
or disability that limits or prevents the fulfillment of a role that is normal (depending on
age, sex, social and cultural factors) for that individual.
Taking accidents as an example, the above terms can be explained further as follows:
Accident .................................................. disease or disorder
Loss of foot ........................................... impairment
Cannot walk .......................................... disability
Unemployed .......................................... handicap.
POPULATION IN MILLIONS
1990 2025
Table 2.3: Global estimate of prevalence of moderately and severely disabled people, based on the UN
population projections for 1990, and on assumptions about disability made by Dr.Einar Helander, UNDP.
Causes of Disability
Macro-economic Conditions
The prevalence and patterns of disabilities are affected by state of health of individuals,
and by the social (family and community) and physical environments, which sustain them.
Personal, family and environmental health is in turn strongly influenced by economic trends
including trends in the prevalence of poverty and inequity. Inequitable economic and social
policies are contributing to prevalence and patterns of disabilities today and will do in
foreseeable future.
To maximize profits, production is often located wherever costs are lowest, regulations
lax and workers least likely to organize for better working conditions and fairer wages.
This can result in high rates of accidents, poisoning from toxins, loss of hearing and vision
and health deterioration.
Disability: Definition and Classification 9
Nutritional Deficiency
In theory, world produces more food for everyone, yet, problems remain concerning
equitable distribution to those in need of food. Common micronutrient deficiencies that
will continue to affect disability include:
• Vitamin A deficiency: blindness
• Vitamin B complex deficiency: Beriberi, Pellagra, Anemia
• Vitamin D deficiency: Rickets
• Iodine deficiency: slow growth, learning difficulties, intellectual disabilities, goiter
• Iron deficiency: which impedes learning and activity and is cause of maternal mortality also
• Calcium deficiency: osteoporosis.
Chemical Substances
Substances—drugs like thalidomide, glutethemide in the past have contributed for children
born with birth defects.
Pesticides, oil fires and decontaminating agents (reproductive dysfunction), insect
repellents, anti-nerve gas pills, vaccination for anthrax and botulism, instances of terrorism
where nerve gas is used constitute chemical substances as a cause.
Table 2.4: Causes of disability and estimated prevalence of moderately and severely disabled people
in the world, estimates for 1990
TYPES/CLASSIFICATION OF DISABILITIES
There are six major types of disabilities. They are:
• Locomotor disabilities
• Visual disabilities
• Communication disabilities
• Mental retardation
• Cerebral palsy
• Mental illness
• Multiple disabilities (more than one disability in the same person).
Autism, learning disabilities, etc emphysema, cancer, heart disease, multiple sclerosis,
etc. are other types of disabilities.
Disabilities may be classified as mild, moderate, severe and profound. Categorization
of disabilities is a difficult task. Government of India has suggested certain norms. Disability
Act of 1995 also specifies certain norms for classification based on severity to help
certification for receipt of certain benefits under different schemes. Some of these which
are especially useful for categorizing persons with visual and hearing disabilities and mental
retardation are given in Tables (Annexure III).
12 Community Based Rehabilitation of Persons with Disabilities
Table 2.5: Most common felt needs concerning disabled people in the developing countries
BIBLIOGRAPHY
1. Maya Thomas, Pruthvish S. “Identification and needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives “Monograph Published by ActionAid India (1993).
2. Park K. “Text Book of Preventive and Social Medicine”, Banarasi Das Banot (Publishers) Calcutta, 17th Edition
3. UNESCAP, Bangkok “Prospects for persons with disabilities” in “Millennium Supplement on Disability” Action-
Aid Disability News, pp. 70-93, ActionAid Disability News, Vol 11, Issue 1 and 2, 2000
4. UNICEF Nepal—Kit on Disability
Prevention of
3 Disabilities
LEARNING OBJECTIVES
1. The learners should be able to appreciate and explain primordial, primary, secondary
and tertiary levels of prevention measures in disease states/disability prevention.
2. The learners should be able to list prevention programmes under different levels of
prevention.
SUGGESTED METHODOLOGY
• Lecture—discussion using Audio-visual aids.
• Participation in immunisation programme of PHC/Urban Family Welfare Centre;
nutrition demonstration in an Anganwadi, antenatal and postnatal clinics in PHC/Urban
Family Welfare Centre.
PRE/POST EVALUATION
• What is Prevention?
• List preventive measures to reduce the burden of disability.
Prevention of Disabilities 15
Pregnant Mother:
Tetanus Toxoid I Dose 3 Months
II/B Dose 4 to 6 weeks after the first dose
LEVELS OF PREVENTION
There are four levels of prevention:
• Primary prevention
• Secondary prevention
• Tertiary prevention
• Primordial prevention
Prevention of Disabilities 17
Primary Prevention
This includes health promotional and specific protection measures.
Accidents and injuries are a major cause of disabilities. Multipronged approach is necessary. Road
traffic accidents, domestic accidents, industrial accidents, railway accidents burns are important
contributing accidents.
Studies by Dr G Gururaj et al of NIMHANS have proved beyond doubt need, necessity and inevitability
of use of helmets to prevent Road traffic accidents. Studies in Austria have proved beyond doubt
usefulness of seat belts.
While both human and environmental factors contribute to causation of accidents, human factor is most
important. Monitoring and surveillance of accidents and injuries, promotion of safety measures, alcohol
and other drugs, primary care, Elimination of causative factors, legislations, rehabilitation services and
accident research constitute measures for various levels of prevention.
Need of development of “Golden Hour Management” systems in cities and highways need no emphasis?
“Trauma Consortium” of Bangalore is an excellent example to address golden hour management.
Secondary Prevention
Early diagnosis/early identification of disease and treatment/management of disease/
injury/event will help reduce occurrence of disability. Examples of this are: early
identification of “patches” due to leprosy and institution of prompt treatment will prevent
occurrence of disabilities.
Early recognition of vit A deficiency and prompt treatment, nutritional supplementation
will prevent occurrence of blindness due to vit A deficiency.
Screening for cataract and surgery will help people have better vision.
Identification, needed surgery, therapeutic measures will prevent contractures and
deformities in persons with paralysis due to poliomyelitis.
Tertiary Prevention
The above example of prevention of contractures and deformities due to post-polio residual
paralysis may be included under “disability limitation” instead of early diagnosis and
treatment.
“Disability limitation” and Rehabilitation come under tertiary prevention. In a country
like India where we see high prevalence of childhood disability, there is need to focus on
both primary prevention and early diagnosis and treatment with equal importance. Early
identification and early intervention will help prevention of further disabling conditions.
Disabilities and restrictions, needless to say “Rehabilitation” is also equally important in
a country like ours where more than 45 million people with disabilities live.
Approach of development of comprehensive health programmes is necessary for any
country. All facets of Health Promotion, specific protection, early diagnosis and treatment,
disability limitation and rehabilitation need to be simultaneously addressed in a developing
country like ours where the population is large and number of people with disabilities is
more.
Prevention of Disabilities 19
Childhood disabilities are more common in developing countries and disabilities due
to chronic illness and age is more common in developed countries. Disability prevalence
increases with age. Prevention of communicable diseases, improved nutrition, improved
maternal and child health care has reduced childhood disabilities in developing countries.
But, increased life expectancy and diseases of growing age have contributed to disabilities
in old age. In our country we have tackled communicable diseases to some extent and
increased our life expectancy also. We have still the challenge to face both communicable
and non-communicable diseases.
Primordial Prevention
Another important level of prevention is primordial prevention. This specifically helps us
prevent occurrence of diseases of hypertension, diabetes, coronary artery disease, stroke,
obesity, etc if intervene in early childhood, childhood and adolescence; prevents occurrence,
suffering and disabilities due to non-communicable diseases, especially if we change our
lifestyle. Health education and counselling on diet, physical activity and tobacco use at high
school level may help in attempting primordial prevention. Basically, primordial prevention
aims at risk factor prevention.
Premarital Counseling
This is an important aspect of disability prevention. Prospective genetic counseling gives an opportunity
for disability prevention. This will be especially helpful in Sickle Cell Anemia and Thalassaemia.
Heterozygous individuals are to be identified and prospective individuals who will marry need to be
screened for heterozygotes.
Most often genetic counseling is retrospective. Genetic counseling is often sought in connection with
mental retardation, psychiatric Illness, congenital abnormalities and inborn errors of metabolism.
Indian Council of Medical Research (ICMR) has established Genetic Counseling centers across the
Country in various Medical Colleges. Two such centers are in St.John’s Medical College and MS Ramaiah
Medical College, Bangalore. World Health Organization suggests to Countries to establish Genetic
Contd...
Prevention of Disabilities 21
Contd...
Counseling Centres wherever diseases due to malnutrition and infectious diseases coming down and
where problems like Thalassaemia and Sickle Cell anaemia are highly prevalent.
Depending on culture and tradition of communities, contraception, sterilization and pregnancy termination
are advised in retrospective approach to genetic counseling.
Genetic counseling can have greatest impact only when prospective approach is made, i.e. before they
have developed symptoms themselves or before the affected child is born.
X-rays, Ionizing radiation and Chemical agents should be avoided during pregnancy and exposure
to gonads to be avoided al times.
A good example of Intersectoral coordination is Integrated Child Development Services Scheme in the
country. For rehabilitation, such intersectoral coordination is attempted in District Rehabilitation Centre
Scheme, National Programme for Rehabilitation of Persons with Disabilities and Grameena Punarvasa
Yojana of Government of India. Intersectoral coordination is needed at Policy level, at District level, at
Field level between Health Workers, Anganawadi Workers, Teachers, NGOs, and local Community.
BIBLIOGRAPHY
1. Clark and Leavell “Public Health Administration”.
2. Einar Helander “Prejudice and Dignity “UNDP, New York.
3. Hobson and Hobson “Preventive Medicine and Public Health” UK.
4. Park K “Text Book of Preventive and Social Medicine “Banarasidas Banot (Publishers), Calcutta.
Disability
4 Identification
IDENTIFICATION OF DIFFERENT DISABILITIES
Identification and needs assessment of persons with disabilities; surveys/records/key
informant inquiries/participatory rural appraisal/conduct of surveys.
LEARNING OBJECTIVES
At the end of session of three days, the participants should be able to:
• Understand and able to identify persons with common disabilities
• Conduct a disability survey and make needs assessment, prepare a short report.
OUTLINE OF CONTENT
• Methods of identification of persons with locomotor disabilities
• Methods of identification of persons with visual disabilities
• Methods of identification of persons with hearing impairment/speech problems
• Methods of identification of persons with mental retardation
• Methods of identification of persons with epilepsy
• Methods of identification of persons with leprosy
• Preliminary steps in initiating community based rehabilitation initiatives
• Village records, key informant survey
• PRA in disability work
• Survey methods
PRE/POST EVALUATION
• How to identify different disabled conditions?
• How to do needs assessment?
• How to conduct a survey of disabled persons?
• What is community diagnosis?
• Who are key informants?
• What is PRA?
Disability Identification 23
President of the Menninger Foundation, Topeka, Kansas, USA - William C Menninger drew up following
questions to help measure one’s on Mental Health status: According to Dr. Menninger, help is necessary
if answer is “Yes” to any of the questions:
1. Are you always worrying?
2. Are you unable to concentrate because of unrecognized reasons?
3. Are you continuously unhappy without justified cause?
4. Do you loose your temper easily and often?
5. Are you troubled by regular insomnia?
6. Do you have wide fluctuations in your moods from depression to elation, back to depression
which incapacitate you?
7. Do you continuously deslike to be with people?
8. Are you upset if routine of your life is disturbed?
9. Do your children continuously get on your nerves?
10. Are you “browned off” and constantly bitter?
11. Are you afraid without real cause?
12. Are you always right and the other person always wrong?
Do you have aches and pains for which no doctor can find a physical cause.
Child 3 to 6 Months
• Baby does not search for source of sound with eyes.
• Baby does not respond to cooing/talk by parents.
Child 6 to 10 Months
• Baby does not respond to name. Ringing bell, or someone’s voice.
• Baby does not understand simple phrases like—no-no; bye-bye, etc. in local language
Child 10 to 15 Months
• Child cannot point to familiar objects or people.
• Child does not imitate simple sounds or words.
• Child does not respond to no-no or name unless he/she sees the speaker.
• Child shows no interest in radio.
Child 15 to 18 Months
• Child does not follow simple directions.
• First words—no/no; go/go; bye/bye in local language not developed.
said at 3 meters, then the child has difficulty hearing. You could also do the test for children
under 6 to make sure.
Watch test and use of tuning fork to differentiate types of hearing loss will be useful
in older children and adults. Audiometry will be the confirmatory test; as well it will help
differentiate degree of disability too.
If a child even at the age of 15 months is not able to talk two word sentences, one must
suspect:
• Nothing/hearing loss/mental retardation.
Other Factors
• Has fits Yes/No
• Has Physical disability Yes/No
• If the child is found to be delayed in any of the stages given from1-11 a
nd if the child has fits or physical disability, suspect mental retardation.
• When you tell the child to do something, does the child seem to
have problems in understanding what is being said? Yes/no
• Does the child sometimes have weakness/stiffness in the limbs,
difficulty in walking/moving the limbs? Yes/no
• Does the child sometimes have fits, become rigid or lose consciousness? Yes/no
• Does the child have difficulty in learning to do like the children of
his/her age? Yes/no
• Is the child not able to speak at all? (To make himself understood in words
or to say any recognizable words. Yes/no
• Is the child’s speech in any way different from normal? (Not clear enough
to be understood by people other than his immediate family. Yes/no
• Compared to other children of the same age, does the child appear in
any way backward, dull or slow Yes/no
If any of the above items elicits ‘yes’ as an answer, suspect mental retardation.
• Drooling of saliva.
• Uncontrolled passing of urine and stools.
• In a severe fit, the person suddenly falls, often with little or no warning, and may make
a strange cry. This can frighten people.
• At first, the body becomes stiff and then loose.
• The arms and legs make unusual movements, which can be vigorous. Froth and bubbles
of saliva may appear at the mouth and may be colored red by blood if the person has
bitten his tongue or cheeks.
• People who see this happening sometimes find it upsetting and are afraid. This is quite
natural.
• A fit may last only a few seconds, or a few minutes. The person is not in pain and his
life is not in danger unless he is in the way of traffic, in water or falls near fire.
Name of the child Age Sex If ‘Yes’ is the response to questions 1, 4, 5, 7 to 10,
and ‘No’ to questions 2,3 and 6 details of
problems identified
1.
2.
3.
4.
Source: Maya Thomas and Pruthvish S “Identification and needs assessment of beneficiaries in
community-based rehabilitation initiatives” Monograph Published by Action Aid India , Bangalore (1994).
32 Community Based Rehabilitation of Persons with Disabilities
Survey Methods
The formulation of an effective Community-based Rehabilitation Programme begins with
defining the magnitude of the problem of disability in the community. Although costly and
time consuming, identification surveys are much cheaper than intervention itself. The survey
may suggest that the problem is far less than originally anticipated, and may also suggest
how rehabilitation activities (organizing disabled people, their family members, medical
and surgical treatment, physiotherapy, speech therapy, occupational therapy, activities of
daily living skills, vocational training, job placement, maintenance allowance, other social
security measures, recreation, leisure activities) can be planned.
Also, the survey may identify the types of disabilities and those peculiar to the
geographical setting (urban/rural/tribal).
A systematic and comprehensive preliminary investigation should preferably include the
following:
a. Awareness programmes in the community using locally familiar/popular media and
audio-visual presentations to create awareness among the people of the proposed
interviews and surveys. Various aspects of disability may be covered in these
Disability Identification 33
programmes using handbills, video films, posters, etc. Local organizations such as
schools, health centers and so on should also be involved. It is important to assure and
ensure that services would be linked with the survey.
b. Collection of information from census reports of the villages/slums/tribes. Contacting
officials of departments of economics and statistics, social welfare, development and
panchayat, disabled welfare and non-governmental organisations working in the area
will be an additional help.
c. Interviews using structured questionnaire conducted with those individuals likely to be
aware of the problem, e.g. formal and informal leaders, local functionaries of education,
health, panchayat, social welfare, etc. traditional dais, elderly members of the community,
Anganawadi and Balwadi (preschool teachers) workers, members of mahila mandals
(women’s groups) and youth organizations, rehabilitation centers and special schools
(if any).
d. Identification (prevalence surveys) determines the number of individuals in the sample
(or the whole population surveyed) with a particular impairment, disability and handicap
at that point of time. When this represents the population under consideration, the
prevalence rates within the sample represent the prevalence within the population as
well.
e. Surveys involving assessment (at least preliminary assessment) components are the most
efficient and definitive (unbiased means) of:
• Establishing the nature, magnitude and geographical distribution of different
disabilities.
• Determining whether it manifests itself as a significant public health problem.
• Selecting suitable strategies for intervention.
• Providing a baseline for evaluating the effectiveness of future intervention
programmes.
• A survey of the entire population in the chosen target area will give more accurate
result.
Enumerators need to visit each house in the cluster and keep a careful record of those
that are unoccupied, do not have disabled persons, or have disabled persons who are not
present at that time or where parents refuse to cooperate. Such data are important to
evaluate results or bias. If large number of families with disabled persons is away in the
fields or refuses to cooperate, it is reasonable to surmise that their characteristics and risk
of disability might be different from those of families that were interviewed.
If the houses are found locked, repeat visits should be made either early in the morning
or late in the evening (depending on the occupation of local people). Information can be
collected from neighbors if repeat visits also fail.
Uniform case definitions are to be evolved and used by all the enumerators.
If cases of leprosy are identified, they should be referred to a nearby government health
facility. Cured/arrested cases of leprosy with physical deformities may be referred for
rehabilitation on a case-by-case basis. Disabilities that might have resulted from untreated
leprosy may also be considered for rehabilitation.
The supervisors must check the accuracy of the enumerators by reinterviewing at least
10 percent of households, checking the needs assessment of all people with disability and
participating in the analysis of data. All proformae used should be reviewed at least twice
for legibility, accuracy, and completion before entry into computer. Special edit programmes
should check computer entry.
Interview techniques should be standardized, and poor quality unenthusiastic workers
should be replaced. It is advisable to devote one day every week for data entry into master
charts so that data collection and compilation end almost simultaneously.
A summary report must be prepared for each village/slum/tribal area and a consolidated
report compiled there from. The report should specifically touch upon:
a. Facilities of health, formal and informal education, vocational training, job placement,
self-employment that are locally available.
b. Other organizations—Govt./NGO working in the area with whom collaboration is
possible.
c. Leaders who could be involved to generate community involvement and participation
in CBR work.
d. Approximate number of persons with disabilities.
e. Needs assessment of persons with disabilities.
Undertaking identification and needs assessment survey ultimately helps in making a
community diagnosis of the problem of disability. Once this is complete, intervention needs
to be planned in consultation with other members in the team. A community diagnosis
helps in proper budgetary expenditure and makes best use of available resources. The first
step towards intervention will be detailed assessment of individual persons with disability.
One may develop a home-based record for monitoring and evaluation from this stage.
BIBLIOGRAPHY
1. Dept. of Disabled Welfare, Govt. of Karnataka (1992) Survey report, Schedules and guidelines used for statewide
disability survey in the State of Karnataka.
2. Dept. of Social Welfare, Govt. of Madhya Pradesh (1996) Survey report, Schedules and guidelines used for
statewide disability survey in the State of Madhya Pradesh.
3. Einar Helander “Prejudice and Dignity“ UNDP.
4. ICMR Center for Advanced Research on Community Mental health “features of mental disorders” Department
of Psychiatry, NIMHANS, Bangalore, India 1988.
5. Joseph Abramson “Survey Methods in Community Medicine”.
6. Larson H (Ed) “Childhood Disability Information Kit“, UNICEF Katmandu, Nepal, 1983.
7. Maya Thomas and Pruthvish S “Identification and needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives“ Monograph Published by ActionAid India (1993).
8. Minaire P “The use of International classification of Impairments, Disabilities and Handicaps (ICIDH) in
rehabilitation” Strabourg, Council of Europe, Publications and Documentation Division, 1989.
9. National Institute for Mentally Handicapped “Mental retardation—A manual for Village Rehabilitation Workers”,
Secunderabad, India, 1988.
10. NSSO (GOI) A report on Disabled Persons 47th round, July to Dec 1991 Report No. 393.
11. Pahwa A (Ed) Manual on Community Based rehabilitation District rehabilitation Centre Scheme, Ministry of
Welfare, Government of India, New Delhi, 1990.
12. Park JE and Park K “Text book of Preventive and Social Medicine “Banarasidas Banot, Calcutta, 1989.
13. Rajendra KR “Application of PRA in Therapeutic interventions in rehabilitation“ ActionAid Disability News
Vol.10 No 1 and 2, 1999.
14. “Sarvekshana” Journal of Sample Survey organization, dept. of Statistics, ministry of Planning, New Delhi
Vol VII No 1-2 1983.
15. World Health Organisation WHO/RHB/96.3 Guidelines for Conducting, Monitoring and self assessment of
Community Based Rehabilitation.
16. World Health organization “Training in the Community for people with Disabilities“ Geneva 1989.
Early Identification
and Early Intervention
5 for Disabilities
LEARNING OBJECTIVES
At the end of the session, the participants should be able to:
• Observe children and observe milestones of development
• Recall milestones of development; use development checklist
• Appreciate need and usefulness of early identification and early intervention
• Appreciate the need for involving parents/grassroots staff in early identification and
early intervention
OUTLINE OF CONTENT
• Tips for early identification of disabilities
• Development check lists, child guidance clinics
• Need for skill transfer to grassroots
• Perspectives of UNICEF and UNESCAP
• Development milestones.
SUGGESTED METHODOLOGY
• Review of milestones of development of normal children
• Review Denver scale/Bayley’s scale
• Lecture/discussion
• Task analysis of children under 6 in special schools/select children in pre-schools/
Anganawadis.
PRE/POST EVALUATION
• What are normal milestones of development?
• Can we involve parents? Grassroots in development screening?
There are an estimated 12 million disabled children in India. Yet, the subject of childhood
disability has been neglected. Early detection is essential as early intervention is the most
beneficial. It is now accepted that intelligence is not genetically fixed, but can be significantly
influenced by the environment, especially in early childhood.
Early Identification and Early Intervention for Disabilities 37
BIBLIOGRAPHY
1. Park K, “Text Book of Preventive and Social medicine” 7th Edition, Banarasidas Banot (Publishers) Calcutta!.
2. Website of UNICEF.
3. Website of UNESCAP.
Concept, Principles,
Components of
Community-based
6 Rehabilitation
LEARNING OBJECTIVES
Students must be
• Able to differentiate Institution-based rehabilitation, outreach programmes and
community-based rehabilitation programmes
• Able to define community-based rehabilitation; list principles and components of
community-based rehabilitation
• Able to list needed logistic measures for initiating community-based rehabilitation
programmes.
OUTLINE OF CONTENT
• Institution-based rehabilitation; Outreach Programmes; Governmental Effort
• Definitions, Principles mooted by World bodies
• Examples of community-based rehabilitation programmes in India
SUGGESTED METHODOLOGY
• Posting in a community-based rehabilitation project/field programme for one month—
in a government/NGO set-up.
PRE/POST EVALUATION
• What is Institution-based rehabilitation?
• What is community-based rehabilitation?
• What are outreach programmes?
• List needed logistics for initiating community-based rehabilitation programmes
• What is development?
India has a population of 100 crore and more; it is estimated that little more than
population of Australia is added every year. Population increase is the bottleneck for
development in most developing countries.
42 Community Based Rehabilitation of Persons with Disabilities
Disability related issues take back seat often. Prospects of establishing Institutional base
for rehabilitation will not only be cost-intensive, but also impractical keeping in mind spread
of population across more than 6 lakh villages and more than 3000 towns and cities. It
becomes obvious and necessary to evolve a system of rehabilitation which is cost-effective,
appropriate and which will be accessible and affordable to people. While institutional bases
will be valuable as resource bases, there is need for a community-based rehabilitation focus
in each and every village and urban pocket. Should we employ rehab manpower in all
villages? or should we train local manpower—family and community workers in the process?
Latter appears more appropriate. Should we train personnel of the existing essential services
in the villages and slums—teachers, anganawadi workers, health workers, and panchayat
workers as facilitators? Should we focus and ensure responsibility for rehabilitation to
disabled persons themselves, their immediate kith and kin, and the family members? Should
we train community workers exclusively for rehabilitation?
In India, there are many attempts in this direction. Attempts and approaches have been
innovative and practical, sustainability of programmes have been a challenge.
Institution-based Rehabilitation
Homes for the disabled, special schools for visually impaired, special schools for children
with hearing impairment, special schools for children with mental retardation, cerebral palsy,
have been the usual pattern. Though residential schools are available, running these schools
from morning till evening is more common. Assessment, informal education, vocational
counselling and training, use of aids and appliances are common services offered. Often
these are run by NGO/private management and depend on external funding, more children
from middle and upper class are benefited and only a meager number of children have
access since number of schools are less and located only nearer to/in towns and cities. A
substantial number of these kinds of institutions are run with funding from state/central
government source and has been the approach by government for many years.
Positive points in this approach include—more focus for special children, opportunity
for individual planning and parents have time to attend to work. On the negative side,
cost-intensive nature and difficulty to establish special schools in villages, towns and cities—
number of institutions and rehabilitation manpower needed is enormous, parental
involvement will be less and sustainability of programmes becomes questionable on long
term, transportation of children from home to school and back will be a critical area.
Camp Approaches
Many non-governmental agencies and governments have tried organizing camps for
screening for surgery, assessment, distribution of aids and appliances, issue of disability
certificates, etc for children/adults with disabilities in many places and is a feature even
now. On the positive side we notice reach of more people, reach to remote areas where
rehabilitation services are not available; on the negative side we notice questionable follow-
up services. A few organizations have tried to evolve systems for systematic follow-up
and achieved success too. It may be worthwhile mentioning that large scale camps are
Concept, Principles, Components of Community-based Rehabilitation 43
organized by government of India with the help of community and NGOs through
ALIMCO—largest manufacturer of aids and appliances for persons with locomotor
disabilities in the country. Ashagram—a leading NGO in Bharwani in Madhya Pradesh has
conducted many such camps on a large scale in the state of Madhya Pradesh.
Outreach Programmes
Some NGOs in certain cities have tried to develop mechanisms to ensure rehabilitation
services in slums through periodic visits by specialists, social workers and rehabilitation
workers. Often, this has been the feature in many slum area programmes. Attempts have
been made to involve the families, disabled people, communities, local governments, special
schools, hospitals, etc.
Attempts have been made to organize parents of disabled children; adult disabled—
to stand for their rights. Approach of association of people with disabilities in Bangalore
is a notable successful attempt in this direction. Similar attempts have been noticed in Karkar
Dooma slums in New Delhi by Amarjyothi Charitable Trust and Baroda Citizen’s Council.
Action Aid India, a UK-based International NGO has supported these programmes.
Challenges
While attempts have been made to reach persons with disabilities through these approaches,
question is one of large population of India and need for scaling up operations on a large
scale. Second challenge is how to make it a priority issue as a community’s realization and
make it sustainable. How to go about in this direction?
Government Programmes
We see many attempts by governments to address the issue of disability. Government of
India supports more than 600 NGOs across the country for disability programmes every
year. Both government of India and state governments to support disabled persons with
aids and appliances, maintenance allowance, support disability programmes by NGOs, have
evolved schemes. Recently, special surveys have been conducted to identify persons with
disabilities in the states of Karnataka (1991-92) and Madhya Pradesh (1995). A special
question was included in census questionnaire of 2001.
of others, have resulted in pushing persons with disabilities in to the margins of society
and have denied them their rights.
Community-based rehabilitation focuses on the needs of disabled individuals as well
as the involvement and responsibilities of the family and of the community in which the
persons with disabilities are living. The goals of community-based rehabilitation can be
expressed as:
a. To enable persons with disabilities to participate as fully as he or she chooses in family
life and in other social activities.
b. It provides opportunities for persons with disabilities to learn and to develop their
abilities and skills to be able to participate and integrate fully in the society.
c. To raise awareness in the community/society to achieve a barrier free environment, to
enable the persons with disabilities to participate in all activities without discrimination.
An Exercise
List the activities you identify as priority to work with persons with disabilities in your
area. Your strategy and broad plan of action should take into account,
a. The environment and physical conditions of the area;
b. Culture and traditional practices of the people;
c. The services and resources that are already available in your area;
d. The resources and capacity of your organization to implement the programme;
e. The support you require, besides finances, in implementing the activities.
Sri Ramana Maharishi Academy for the Blind (SRMAB) was initially running a special school for visually
impaired from 1969 in Bangalore, India and Agro-based training centre for all category of people with
disabilities at Tirumurthy Rural Development Centre (TRDC), Jakkasandra, near Kanakapura in
Karnataka, India from 1985.
Later the Academy started its activities through community-based rehabilitation. In this endeavour
Sourabha was the first one.
Sourabha (Relief Approach/individual based) was started to function in Kanakapura taluk from 1990.
As the project and the approach were new it started as “Relief Approach/individual based”. In this
approach the project started to rehabilitate the people with disabilities at their doorstep. The rehabilitation
services were like providing aids and appliances, financial assistances for the economic empowerment,
therapeutical skills, non-formal education and other health aspects giving importance to prevention,
early identification and awareness.
The project covered a target area of 148 villages with 1800 people with disabilities as the target group.
The project span was 10 years, i.e. from 1990 to 2000.
Based on the mid-term evaluation, Sourabha adopted a new methodology for the future years, keeping
the results of mid-term evaluation then onwards Sourabha started organising Self Help Groups (SHGs)
at village level, Hobli Level Rehabilitation Council at Hobli level and at A Federation at Taluk level
and started providing more attention towards severe people with disabilities. Sourabha in its life span
has undergone the following roles.
1) Provider
2) Guider/supporter
3) Facilitator
Gramarakshe (Rural Development Approach)
Through the support of International Agriculture and Training Programme, UK the project started providing
the services to Farmers, Children and Women – it was a three dimensional approach on the concept
of agriculture and its allied field. In order to run the programme more effectively new groups were formed
viz., Credit Management Group. Later, the same was developed as a Cooperative Society at Kodihalli
Hobli. As if the programme was for rural farmers—the parent organisation was working for the welfare
of persons with disabilities (PWD) integrating them into the mainstream. The target area was 75 villages
of Kodihalli Hobli of Kanakapura taluk, which covered both rural farmers and people with disabilities.
RR/ADD/September 2003
48 Community Based Rehabilitation of Persons with Disabilities
STRATEGIES ON IE
Children with special needs should be included in all the educational arrangements made by the state.
This idea has led to the concept of IE where the challenge is that of developing a child centered pedagogy,
for all children including those who have serious disadvantages.
To facilitate inclusive education MORE has been striving to achieve a clearly stated policy, understood
and accepted by the school system and the wider community. Such a policy should allow for curriculum
flexibility thereby reducing the pressure on teachers and pupils alike. At the primary school level the
community should be in a position to determine what children learn based on the needs and capabilities
of the given area. MORE has been encouraging the CBR Groups to debate on the minimum
competencies that their children should achieve at the primary school level. This discussion has thrown
up a lot of ideas on how make education more activity based and joyful.
MORE has been carrying out teacher orientation programmes so that they could pick up skills to deal
with children with special needs within the regular school system. In one of such programmes a teacher
said, “I always used to think that any disabled child must be put in a special school. But now I am
convinced that they need not go far away from their homes. They too can learn with other children.
After all they too are children!” The project has also developed teaching learning material, which are
being used both at the classroom and home. As a result of these measures the number of children
with disabilities enrolled at government schools has increased significantly. The following table gives
data pertaining the 100 primary schools within the project area:
MORE pays special attention to facilitate girls with disabilities and children with severe or multiple
disabilities access education. They have the same rights as others in the community to achieve
independence as adults and should be educated to the best of their potential towards that end. In
exceptional cases where children are placed in special schools, their education need not be entirely
segregated. MORE has been working towards facilitating part-time attendance at regular schools.
MORE has been providing opportunities for children with special needs so that they can bring out their
creative talents. These talents have demonstrated to the larger community that persons with disability
too have rights. The project has promoted drama, art and sports events highlighting the need for barrier
Contd...
52 Community Based Rehabilitation of Persons with Disabilities
Contd...
free environment. The project hopes that these activities in the long run will add to the empowerment
process of persons with disabilities.
Equipping Parents
As part of building capacities of the most marginalized people MORE has been training parents of
disabled children on therapeutic and educational aspects. The project trained 310 parents during 2003
through disability specific workshops and imparted knowledge and skills relating to upbringing of their
children with disabilities.
Special Skills
As part of inclusive education MORE assisted children with communication and visual disabilities to
learn Sign Language and Braille Education respectively. In order to make these special skills more
workable the project tried to popularise them within the community. MORE enhanced the learning
processes at schools through the provision of teaching materials and by encouraging co-curricular
activities. This facilitated the schools to become more inclusive. Simple material was used for this purpose
that relate shape and colour.
Community Centers
As part of generating resources within the community MORE encouraged the CBR Groups to identify
suitable places for rehabilitation activities. During 2003 the CBR Core Groups were able to set up 6
community centers in nodal villages where DAP and other members were able to get together and
carry out common activities such as therapeutic exercises group meetings, health camps etc. Such
meetings encouraged community caring mechanism.
Cultural Teams
Human Resources are the best resources that are available in the community. MORE trained 3 groups
of DAP in different cultural activities like group songs, group dances and street plays. These groups
can give packages of cultural programmes and were closely associated with all group activities during
the year.
Concept, Principles, Components of Community Based Rehabilitation 53
WHY CBR?
MORE believes that CBR brings rehabilitation know-how to rural and slum communities thereby enabling
people to take responsibility for their own lives. It is implemented through combined efforts of disabled
people themselves, their families and communities. It is a serious effort towards de-institutionalizing,
de-professionalising, and de-mystifying the techniques of rehabilitation.
One of the key aspects of MORE’s work during 2003 was to align the CBR movement with that of Gram
Panchayats (local government bodies) and make it self-sustaining. Consequently the 44 CBR Groups
formed and strengthened by MORE during the past 4 years were re-aligned with that of 38 Gram
Panchayats in the project area. This implied some amount of re-deployment of staff and re-organization
of the structure.
The CBR Panchayats consists of 15 to 30 DAP depending on the size of the Gram Panchayat. The
members elect a President and 5 Disability Activists (one each for LD, MR, CP, SH and VD) for a two-
year term. The president and the Disability Activists form a core group at the CBR Panchayat level.
This Core Group appoints a CBR Worker (CBRW) in consultation with the project staff.
CBRW is a part-time paid worker who is constantly trained by the project so that he/ she is in a position
to provide therapeutic and educational inputs for DAP. MORE today has 38 committed CBRWs who
are increasingly becoming the agents of development apart from disability rehabilitation.
The Disability Activists elect their spokespersons that operate at the Mandal level. Each Mandal has
5 disability-specific spokespersons. These spokespersons in turn elect Disability Leaders to represent
DAP at the district level.
MORE adopted rights based approach for its CBR project during 2003 with a five-pronged strategy.
Referral Support
MORE facilitated the link between the CBR Panchayats and the host of referral institutions in the nearby
cities like Bangalore, Tirupathi, Vellore, and Puttaparthi, besides Madanapalle. The project arranged referral
support fund at the Panchayat level and facilitated the CBR Core Group (consisting of the President, the
Disability Activists and the CBRW) to identify the needy DAP for the medical visits. The project helped the
Contd...
54 Community Based Rehabilitation of Persons with Disabilities
Contd...
CBRWs and Disability Activists to contact the relevant institutions, fix appointments and escort the DAP. The
CBRWs and Activists also ensured that the follow-up measures recommended at these referral centers were
regularly adhered to. More than 40 DAP were benefited by this activity during 2003.
Surgery Support
Although free surgery is available at Government Hospitals, the cost of peripherals such as bandages,
medicines and the like have to be borne by the family. Since these costs are prohibitive for the poor
families, they require support. A Support Fund has been created by the project at the CBR Panchayats
in order to meet the expenses of surgery peripherals, cost of travel for surgery or referrals, etc. The
CBR Core Groups took the responsibility of deciding which family requires how much support. More
than 20 DAP were benefited from this activity.
Equipping Parents
As part of building capacities of the most marginalized people MORE has been training parents of
disabled children on therapeutic and educational aspects. The project trained 310 parents during 2003
through disability specific workshops and imparted knowledge and skills relating to upbringing of their
children with disabilities.
Network
MORE wants to bring together on one platform different CBR Groups to give their voice a joint strength.
This is done at Mandal, District and the State levels. During 2003, the project was able to initiate action
on Mandal and the State level. With regard to Mandal CBR Forums Madanapalle, Vayalapadu and
Kurabalakota have been the opening initiatives of the project. Here the forums are gradually emerging
from the grassroots level and providing appropriate leadership. As far as the State level network is
concerned MORE forged alliances with different national organizations.
Concept, Principles, Components of Community Based Rehabilitation 55
Special Skills
As part of inclusive education MORE assisted children with communication and visual disabilities to
learn Sign Language and Braille Education respectively. In order to make these special skills more
workable the project tried to popularise them within the community. MORE enhanced the learning
processes at schools through the provision of teaching materials and by encouraging co-curricular
activities. This facilitated the schools to become more inclusive. Simple material was used for this purpose
that relate shape and colour.
Within the CBR Panchayats MORE attempted to bring about gender equity through orientation of office
bearers. This ensured that the transactions, benefits and control mechanisms at the CBR Panchayat
level were gender sensitive. Women members are beginning to assert themselves in protecting their
rights.
RESOURCE GENERATION
As part of generating resources within the community MORE encouraged the CBR Panchayats to identify
suitable places for rehabilitation activities. During 2003 the CBR Core Groups were able to set up 6
community centers in nodal villages where DAP and other members were able to get together and
carry out common activities such as therapeutic exercises group meetings, health camps etc. Such
meetings encouraged community caring mechanism.
Disability Certification
Certification by the government authorities is the first step for any rehabilitation service from the State.
It is a matter of right for any DAP to be certified and this needs to be carried out at the closest point
possible. MORE has facilitated 178 new DAP to be certified during 2003. Disability certification is a
continuous process at the project. Besides MORE has assisted the district administration in conducting
5 Certification Camps outside the project area.
CONCLUSION
Thus, MORE is following CBR methods in order to help DAP overcome their impairments while they
continue to live with their families within their community. Their abilities will find no bounds when they
are recognized and given the right opportunities. Education is a fundamental requirement in this process
and therefore there is a great need for making it more relevant and universally available. Inclusive
Education (IE) is very integral to any CBR programme. A child-centered pedagogy is beneficial to all
students and consequently to the society as a whole. Child-centered schools are moreover, the training
ground for a people-oriented society that respects both the differences and the dignity of all human
beings.
Contd...
With Leprosy work as its focus, AIFO provides support to projects in developing countries, without any
discrimination on the basis of colour, race, religion, gender etc. It also supports rehabilitation of persons
with disabilities and programmes for vulnerable children with a community-based approach.
AIFO began its work in India in the early 1960s by supporting activities carried out by NGOs and also
supports National Leprosy Eradication Programme (NLEP) District Technical Support Team (DTST) in
24 districts in various states.
Working with over 40 NGOs spread across the length and the breadth of the country, AIFO which made
considerable progress in work of leprosy eradication has taken its activities one step further by making
community-based rehabilitation an integral part of all its activities.
Founded on the spirit of love for the destitute which found full expression in a great French social reformer
Raoul Follereau, AIFO has successfully embraced the concept of CBR which promotes the overall
development of an individual without uprooting the person from the community.
AIFOs reach has extended to remote villages of Assam which do not even have proper access roads
and also to interior villages in the dry lands of Bidar, a backward district of Karnataka.
Economic and social rehabilitation form an integral part of CBR work at AIFO. Education and health
issues of the community are also given equal importance. Facilitating income generation, job placements,
career guidance, establishing savings groups are some of the tried and tested methods of CBR practised
by AIFO.
Perhaps the most essential part of AIFOs programmes includes intensive training in important issues
relating to legislations, advocacy, information about disabilities, formation of Self Help Groups etc.
The result is evident in that, several Disabled Persons Organizations are not only empowered to take
control of their lives, but are now ready to rehabilitate their entire community. This is a reflection of
the meaning of complete rehabilitation and inclusion as per AIFOs experience in the field.
BIBLIOGRAPHY
1. ILO WHO UNESCO (1994) “Joint Position Paper” Community Based Rehabilitation Contributions made by
various projects within India and abroad for BOX items.
2. Rajendra KR and Pruthvish S (1997) Community Based Rehabilitation, Paper presented in workshop on
“Developing Indicators for Monitoring and Evaluation of CBR” - workshop facilitated by ActionAid India
1997.
3. Ramachandran, ADD India (2004) Community Based Rehabilitation.
Planning and
Implementation of
Community-based
7 Rehabilitation
LEARNING OBJECTIVES
At the end of the capsule, the participants must be able to participate in a planning process
of Community-based rehabilitation and contribute technical expertise. The participants must
be able to develop a mind-set towards demystification of technical aspects.
OUTLINE OF CONTENT
• Three Approaches for Public Health
• Knowledge, Attitude and Practices
• Skills, skill transfer
• Demystification attempts
• Appropriate Technology in Community-based rehabilitation
• Training of family members
• Training of volunteers
• Training of community members
• Planning Community-based rehabilitation in rural areas
• Planning Community-based rehabilitation in urban settings
• Planning Community-based rehabilitation in tribal settings
• Initiating Community-based rehabilitation activities
• Resource mobilization
SUGGESTED METHODOLOGY
Students are posted to a Community-based rehabilitation project/DRC (District
Rehabilitation Centre) scheme for one week; they participate in all activities of the project—
planning, monitoring, implementation; work with grassroot level workers; and prepare a
report.
Students choose a research question in Community-based rehabilitation and address it—
over period of month; under the guidance and supervision of a teacher.
Planning and Implementation of Community-based Rehabilitation 59
PRE/POST EVALUATION
• What is demystification?
• What is appropriate technology?
• List steps in planning Community-based rehabilitation
Government Sector
• National institute of mentally handicapped, Secunderabad
• National institute of hearing handicapped, Mumbai
• National institute of visually handicapped, Dehradun
• National institute of orthopaedically handicapped, Calcutta
• National institute of rehabilitation research and training, Cuttack
• All India institute of speech and hearing, Mysore
• National institute of mental health and neurosciences, Bangalore
• Universities across the country, for training of physiotherapy
NGO Sector
• Sri Ramana Maharishi academy for the blind, Bangalore
• Mobility India, Bangalore
• Association of people with disabilities, Bangalore
Planning and Implementation of Community-based Rehabilitation 61
Others
With more than 45 million disabled people in India, access and opportunities being very
limited added with problems of illiteracy and ignorance, minimal rehabilitation manpower
available makes therapeutic interventions reach only a few. In this context it becomes
essential to train local community people and family members and person with disability
themselves to help themselves. Here, skill transfer becomes important.
Demystification Attempts
There are attempts by NGOs like Sri Ramana Maharishi academy for the blind in Bangalore
and rehabilitation council of India set up by Government of India to train health, education
and development workers, community and family members in skills required for
rehabilitation.
Experience of ActionAid India in more than 20 community-based rehabilitation projects
it initiated and supported with technical and managerial input depended on local volunteers
with pre-university qualification as change agents, who in turn trained family members;
indicates that demystification is possible.
What should be the content and what should be the methodology of these training
endeavors?
2. Organisational structure
a. Risk factors anticipated
b. Expected outcomes what may be a budget estimate for 1-year/3-years/5-years?
c. How monitoring is made/How evaluation is made?
d. What and how records will be kept?
e. Acknowledgement of people who helped in the development of proposal.
Step VI: Start Systematic Work once Resource Support is Assured. Till then Help
People Ad hoc
• Monitoring and recording systems
• Recording systems in community-based rehabilitation can be classified thus
• Records for individual persons with disability
It may be a file containing detailed history, preliminary needs assessment, goals for
rehabilitation arrived at in consultation with disabled person, family member and
professional by the grassroots staff.
It may have what is attended to a every stage—including counselling, assessment, aids
and appliances, bus pass, scholarship, vocational training, employment, awareness, exposure
visit, aspirations of disabled people and their families. This record is always with grassroots
staff.
Monthly/Quarterly Reports
This is consolidated from village/slumwise reports every month; analysis made in monthly
meetings and presented to advisory committee.
In addition it may include report of important events during the period, SWOT analysis
of efforts, plan for next three months.
I am M Eswari born to Sri .M. Chandra and Smt M. Munilakshmi at Madanapalli town. I am 20 years
old and I have an elder sister and elder brother. When I was 3 years old I suffered from high fever
and ultimately got polio which resulted paralyzing of both legs disabled me, not to walk my nearest
relatives and parents moved me from hospital and trained their level best using all types of medicines
including visiting witchcraft doctors. Ultimately I was put in the hostel at Arogyavaram, which is run
by Christian Missionary (Bethesda polio home) 6 km away from Madanapalli town. Maids and teachers
have looked me after very well in the polio home. Since I was the youngest, hostel warden has created
Contd...
68 Community Based Rehabilitation of Persons with Disabilities
Contd...
lot of self-confidence in me. I have understood the limitations of life with disability and learnt quite a
lot from my friends who are also sailing in the same boat. I was always first in singing as well as in
sports. Some how I did not concentrate much on studies, hence I failed in 10th class. But hostel warden
as encouraged me to undergo training in tailoring work later; I was asked to go home with Tailoring
Machine. It was a memorable stay for about 13 years at Bethesda Polio Home, which has molded my
life with full confidence lead.
After my arrival at home made me to think of life in a different fashion. On one side, parents were heavily
burdened with financial problems specially my married elder sister with 2 children. Her husband left
leaving her as well as the children as parents and elder brother whose income is not beyond Rs.2500/-
per month. Since we don’t have house, major income is spent on rent, electricity, or bills, along with
school fees. On the other hand, the expenditure on kitchen also high and the situation is of hand to
mouth existence. My confidence and will power made me to take a bold step to help my family by
doing whatever work is possible. Even I worked hard in odd jobs like packing of soaps and cleaning
powders, manufacturing of candlesticks and even working as a part time keeper in public telephone
booth. I felt little bit proud since I am no more burden to them as well as helping them to add to the
income for the family. At this stage I was picked up by a Social worker of MORE who sent me for
‘VIKALANG BANDHU’ Training for a period of 3 months at Thirupati organized by National Institute of
Mentally Handicapped (NIMH). This training gives me lot of insight into the problems of Loco motor
Disability — especially for girls like me to live in the society. I have also understood the various types
of disabilities and solutions to live with disability are a great honor. MORE has molded my life after
the training and I was given the task to work as a representative on locomotor disability to participate
for the welfare of the disabled. MORE has exposed me in to the cultural activities and I was deputed
to Hyderabad. I could sing songs on disability and I felt very happy when my songs were recorded
and the cassette was released with my own hands. There is another memorable event, which has
happened at Hyderabad where I was well treated in Asian Social Fourm (ASF). In the forum I had
a chance to act in a sensational drama where I played the role of representative for locomotor disability.
I shared these memories with friends, relatives and family members who encouraged me to do more
social work for the disabled persons. Later, I have been deputed by MORE to participate in the World
Social Forum (WSF) held at Mumbai along with other disabled persons representing from my area.
This participation has enhanced by knowledge on the problems of disabled, human rights, violation
and social justice. This understanding, especially the interaction with the other disabled persons coming
from other countries has given me the opportunity to learn as the subject with great insight. Today, I
feel confident about my rights and I like to fight for the cause of other disabled suffering at all levels.
Now I feel very strong to bring change in the attitudes of the disabled persons if the chances are provided
with encouragement and not with sympathy.
by
Eswari
Contd...
and Yesodhamma who gave special attention. Yesodhamma taught her many rhymes and a lot of lessons
by oral and aural methods. Gulzar started teaching simple brail. Today Bhoolakshmi has picked up
a lot of things at school. She has made many friends. One of her friends, Kasimvalli also lives in the
village. He has locomotor disability. Both Kasim and Bhoolakshmi have become a good example for
inclusive education in Bhadraiahgaripalle.
Apart from Brail Gulzar has taught Bhoolakshmi orientation and mobility. This enables her to use a
walking cane and move around in new surroundings. She is now well acquainted with the surroundings
in the village. Bhoolakshmi is on the way to becoming an independent person.
After 4 months of training she went back to her home again doing nothing.
Again her parents were convinced to send her to school. Mithrajyothi provided active support for her
studies and convinced her parents. During her training period she was taught Braille script. Now, she
is 19 years old studying in one of the leading Colleges in Bangalore in 2nd year Pre University It is
really a success not only for both Mithrajyothi and Ms.Pria.
CASE STUDY
What better case study can AIFO offer than its own CBR coordinator?
Thirty-four year Jayanth Kumar is a respected senior staff in the organisation taking an active part in
all major decision-making. His visual impairment has never been an issue of contention at the
organisation.
Independently handling the entire CBR work of AIFO in its over 40 projects in the country, Mr Jayanth
Kumar prepares reports , represents AIFO in seminars and workshops at both national and international
level. Not stopping at this, he travels independently into remote areas where AIFO projects are located
and holds training classes for CBR workers there.
Jayanth’s visual impairment was as a result of an accident in childhood. He dropped out of school
and tried in vain in the first three years to get his eyesight restored. When that did not happen, Jayanth
decided to make the best of the situation and enrolled in Shree Ramana Maharishi Academy for the
Blind (SRMAB), one of AIFO supported projects in Bangalore.
His rise from being a student in the academy to his present status as a senior staff at AIFO India, has
been meteoric, inspiring many to follow suit.
Yet, he too faced problems when he first ventured out into the world trying to get admission for
correspondence course in social work. Even to get one person to help him fill up the form was a
monumental and emotionally draining task!.
But that is all in the past. Armed with a master degree in sociology and diploma in community health
management, Jayanth forged on in his career gathering considerable experience on the way. He finally
caught the eye of AIFO representative Mr MV Jose when he was participating in a CBR activity in a
project of SRMAB. The rest, as they say is history….!
Contd...
passed the SSLC examination of 1998-99 in the third class. He then joined at P.S.M.O. College
Tirurangadi for the Pre-degree course opting commerce group. As he was poor in accountancy and
English he failed in the final examination.
Then he learned computer for 7 months. Seshy gave him financial assistance for setting up a STD
booth. Now he earns nearly Rs. 150/- per day. Meanwhile, he could buy three tier Kinetic Honda for
Rs. 25,000/-. He could mobilize Rs. 15,000/- for the parappanangadi Panchayat towards his purpose.
BIBLIOGRAPHY
1. David Werner: Disabled Village Children (Indian adaptation by VHAI), NIMH, Scunderabad.
2. David Werner: Nothing about us without us.
3. Einar Helander—Prejudice and Dignity (UNDP)
4. Maya Thomas and Pruthvish S (1993) “Identification and Needs Assessment of Persons with Disabilities in
Community Based Rehabilitation Initiatives “Monograph—ActionAid India.
5. Personal experiences while working with ActionAid India from 1992 till 1995 and 1996 till 2001.
6. WHO - Training of People with disabilities in the community (Package)
Supervision, Monitoring
and Evaluation of
Community-based
8 Rehabilitation
LEARNING OBJECTIVES
Participants should be able to differentiate supervision, monitoring, evaluation and
surveillance.
Participants should be able to list steps in evaluation of a community-based rehabilitation
programme; list indicators for monitoring and evaluating community-based rehabilitation.
OUTLINE OF CONTENT
• What is supervision?
• What is monitoring and surveillance?
• What is evaluation?
• What are reviews?
• Qualitative methods of evaluation—PRA methods; focus group discussion, attitude
measurement; case studies
• Quantitative methods of evaluation—survey methods; record analysis; functional
assessments
• Evaluation of coverage
• Evaluation of process
• Evaluation of impact
• Community-based rehabilitation indicators
SUGGESTED METHODOLOGY
Lecture Discussion; participation in an evaluation programme; participation in staff meetings
of CBR projects
PRE/POST EVALUATION
• Difference between supervision and monitoring?
• Difference between monitoring and evaluation?
• Why monitoring and evaluation?
• List quantitative and qualitative methods of evaluation.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 75
What is Supervision?
To watch over an activity or job to ensure that it is done correctly.
For example, supervisors watch over grassroots staff whether follow-up physiotherapy
is done correctly. Teachers of physiotherapy watch whether students correctly perform a
specific exercise of physiotherapy.
Parameters of Evaluation
In one of the consultations organized by ActionAid India, following were identified as
parameters of evaluation:
• Involvement of the community
• Organization of services (Institutionalization or formalization of services so that the CBR
programme is sustainable/delegation of powers/training)
• Financial sustainability
• Skill transfer to families and community
• How far the needs and aspirations of people have been met
• Adequacy of professional support and role of the support structure
• Structure/organization/human power
• Reliability in other areas
• Quality of life of PWD
• Extent of social integration
78 Community Based Rehabilitation of Persons with Disabilities
is the best available non-verbal communication system, which builds on available local
knowledge and practices, especially while dealing with people who are fewer literates.
PRA practitioners have developed a wide range of techniques based on the idea that
visualization can help participation. The starting point is thus the collective construction
of maps, matrices, calendars and diagrams on the ground using whatever materials are
locally available.
“Mobility mapping” is one of the tools used to assess the needs of a person with locomotor
disabilities. The person will be motivated to draw the rough sketch of his/her village with
some help from family members. The person will map mobility patterns using the village
map drawn on the ground. This activity enables us to assess the residual potential of the
person, his/her exact mobility pattern, constraints he/she has in going to the community
toilet, school, a friend’s house, the play ground, etc. Also, it is broad indicator of the kinds
of interventions that need to be planned for the individual, family and community to gain
better access to education, training and income generation and better social acceptance.
For further details see KR Rajendra (1999) and Somesh Kumar (2002).
Case Studies
Case studies are written summarily or synthesis of real life cases based upon data and
research.
• Require you to isolate and think through the key issues involved against both theory
and the larger comparative environment
• Identify appropriate strategies for the resolution of the ‘case’
• Weigh the pros and cons of the remedial options/strategies
• Recommend and present a rationale for the best resolution.
Case studies provide an opportunity to include illustrative histories, success stories and
the human element in evaluation reports. Please refer to case study format given at the
end of this chapter. This was one of the formats developed by ADD India. It is useful to
remember that one may adopt case study method only if we are sure that we are going
to intervene and help. Otherwise, it will simply contribute to raising aspirations without
follow-up support.
• The role of the moderator is very significant. Good levels of group leadership and
interpersonal skill are required to moderate a group successfully.
Focus groups can be used at the preliminary or exploratory stages of a study (Kreuger
1988); during a study, perhaps to evaluate or develop a particular programme of activities
(Race et al., 1994); or after a programme has been completed, to assess its impact or to
generate further avenues of research. They can be used either as a method in their own
right or as a complement to other methods, especially for triangulation (Morgan, 1988) and
validity checking.
Focus groups can help to explore or generate hypotheses (Powell & Single, 1996) and
develop questions or concepts for questionnaires and interview guides (Hoppe et al., 1995;
Lankshear, 1993). They are however limited in terms of their ability to generalize findings
to a whole population, mainly because of the small numbers of people participating and
the likelihood that the participants will not be a representative sample.
For further details see article in Amita Gibbs “Social Research Update”.
Observation
Much can be learned by human behavior by observing it. Observation is most meaningful
when it is planned in terms of the formulated hypothesis and of the general scheme of
the study. Observation is helpful especially while doing “village studies:” Following methods
are in practice while following observation:
• Non-controlled, non-participant observation: Physical aspects of the community, social
atmosphere, symbiosis of the population and effects of such living in a social world will
be made by a external observer in Non controlled, non participant observation.
• Non-controlled participant observation: The participant observer shares to lesser degree the
life of the observed group. This sharing may be intermittent and, but active contacts
at close proximity afford intimate study of persons.
• Controlled observation: Controlled observation is generally carried out according to definite
prearranged plans, which may include considerable experimental procedure. A variety
of instruments have come to use—one way screens and mirrors, movement recorders,
sound recorders, motion pictures, rating scales, photographs, maps, observation checklists
and others.
Some of the most intensive studies have been in the area of child behavior. Using
observation methods will help determine change in attitude of a group, community.
Supposing village studies are done before and after CBR efforts, one may find the difference
in the way persons with disability are seen by the family members, self and community.
Attitude Measurement
Community-based rehabilitation has an important area to impact. That is attitude. Attitude
of persons with disability to himself/herself; towards kith and kin, community and vice
versa is the determining factor for the success of integrating persons with disability into
mainstream of society.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 81
Attitude measurement is a difficult task. But, sociologists and psychologists have made
it possible to measure the same. Suppose we measure attitudes before and after community-
based rehabilitation efforts, it will help determine success/otherwise of efforts. Licort scale
is one useful method to develop scales.
Attitude scales, morale scales, character tests, social participation scales, psychoneurotic
inventories have been developed by sociologists. In Allahabad university, an instrument
called DABB has been developed. It is a useful instrument to measure attitudes and of lot
of value for community-based rehabilitation work.
Description
Focus group discussions bring 6-12 people together for a discussion on a specific health
topic. The participants usually have some characteristics in common, such as sex and age,
so they will feel comfortable speaking in the group. For example, a focus group on the
topic of “how young people discuss condoms with their partners” might be made up of
women aged 15-19, while a separate group might be made up of men aged 15-19. It is
recommended that at least 2 FGDs be done with each group. So, in this example, 2 FGDs
with women aged 15-19 and 2 FGDs with men 15-19 are recommended.
An FGD typically lasts from 1-2 hours and is led by a trained facilitator. It is very useful
to have another person present who takes notes but does not participate in the discussion.
In addition, the FGDs should be recorded on audio tape or video cassette for later
transcription and analysis.
Ethical Considerations
Approvals: Before you being in a study, you must obtain certain permissions for ethical,
political and logistical reasons. Some groups you may need to obtain permission include
UNHCR, Ministry of Health, civil authorities in your district, community representatives,
your own organization, partner organizations and individuals interviewed.
Subscriptions for the Focus Group Discussion Protocol definition adapted from Alternative Modes of Teaching and
Learning, Case Studies, the University of Western Australia, Perth, Australia. http://www.csd.uwa.edu.au/altmodes/
to_delivery/casestudy.html
82 Community Based Rehabilitation of Persons with Disabilities
Informed consent: Every individual has the right to refuse to participate in a focus
group, or to stop her participation at any time. The focus group facilitator must respect
this right.
Privacy: Individuals should understand that participation in a focus group is a completely
voluntary activity and that even after the discussion begins they are free to leave. It is
important that the focus groups be conducted in a manner that is comfortable for all
participants, so that they are able to speak openly and honestly.
Confidentiality: All participants should agree at the start of the discussion that anything
discussed should remain in the group and is not to be discussed outside.
No identifying information should be kept in the notes or transcripts. This may mean
deleting names if they are used in the discussion.
Sampling Plan
Focus group discussions, like all qualitative methods, are not intended to be representative
of your population, so participants do not have to be randomly selected. Participants for
focus groups are invited to participate according to the characteristics you identify as
important for your topic. Anyone with the characteristics may participate, but keep the
focus group to a maximum of 12 participants.
In deciding what characteristics are important, think about the factors that
influence attitudes about your health topic as well as the characteristics that will make
people feel comfortable enough to talk openly with each other. Often, characteristics
like sex and age are important, for example, hold separate focus groups for men and
women and for younger and older participants. Other factors may also be relevant,
such as religion, educational level or length of time as a refugee, depending on the topic.
The more characteristics you select, however, the more focus group discussions will be
required, so select only the characteristics that, you believe, strongly influence your health
topic.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 83
Focus group participants are often recruited through local organizations or administrative
structure in the camp or community.
Facilitator Characteristics
Facilitators should be of the same sex as the focus group participants, and may need to
be close in age so that the participants feel comfortable talking openly. The study team
should discuss other characteristics of a successful facilitator, including:
• Language and communication skills
• Familiarity and comfort level while discussing reproductive health topics
• Ability to respect the dignity and confidentiality of respondents
• Previous experience with focus groups or other qualitative data collection methods.
Previous training and experience in sociology, anthropology, psychology or social
work may be helpful for focus group facilitators, as it is important that they have
good skills in listening in a non-judgmental and non-biased way. Getting beyond the
surface answers to the rich underlying information on attitudes, motivation, feelings
and self-perception is difficult, so care should be taken in selecting and training the
facilitators.
Facilitator Training
Allow at least two days for facilitator training, with an emphasis on field practice. At least
3 practice groups should be conducted by each facilitator. The study team should observe
the practice groups and give feedback to the facilitator.
84 Community Based Rehabilitation of Persons with Disabilities
Time Frame
It is best to keep the number of facilitators small—perhaps 1 to 2 male and 1 to 2 female
facilitators—to maintain good standards and to limit the variability introduced by the
facilitators. Each facilitator can conduct at most 2 to 3 focus groups per day, so the time
needed can be calculated according to how many facilitators there are and how many groups
are required.
Analysis Plan
Immediately after each focus group discussion, the facilitator and notetaker should meet
to review the main themes of the discussion. They should summarize patterns of responses
and confirm consensus or conflicts that emerged.
Next, the FGD notes should be typed, removing all identifying information such as
participants’ names. The audio or video tapes should be transcribed. If someone other than
the facilitators will do the analysis, she or he should listen to or watch the tapes in addition
to reading the transcripts.
Responses are analyzed by arranging them in the general categories identified in the
discussion guide. After the responses are arranged, the different positions or opinions can
be identified. The analysts can summarize the various opinions, assess the degree of
consensus or differences expressed by the groups and synthesize the themes or patterns
that emerge.
Use of Data
Focus groups can be used at various stages in a program. They can be used to explore a
new topic; to test ideas in the planning phase of a new program; to identify and solve
specific problems in an ongoing program; and to evaluate programs.
The results from the focus group discussions are intended to achieve the study objectives
and should be reported within that framework. The results should be used to make
decisions about the future of the project. It is important to highlight how focus group
discussion findings are consistent or inconsistent with findings from other sources of
information.
Dissemination
Results from the group discussions should be reported as they reflect the objectives of the
study. All the information collected should be relevant to the creation or modification of
current services to meet the needs of the refugees. Keeping this clear goal in mind should
assist the data analyst in organizing the final report.
A report of the findings of the focus group discussion should be prepared and shared
with project staff and partners. Dissemination to the community should also be done,
emphasizing that the results do not reflect any one person or area but are the synthesis
of many group discussion with many participants.
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 85
Age:
Sex: Male/Female
Disability (specify):
Belong to SC/ST/BC?
If yes, specify:
Occupation, if applicable:
Family details
Total income of the family : Upto Rs. 6,000 per year _________
(specify) Rs. 6,000 – 12,000 per year _____
Rs. 12,000 – 24,000 per year ________
Rs. 24,000 and above per year ________
86 Community Based Rehabilitation of Persons with Disabilities
PERSONAL DETAILS
1. Schooling:
a. Records showing intellectual or mental development.
b. Social, physical, emotional and moral development
c. Age of starting and finishing primary and high schools.
d. Relationship with teachers and pupils
e. Whether he/she had friends and was popular
f. Whether he/she played games.
g. Similar questions to be asked about higher education.
2. Use of leisure time : Hobbies and interests.
3. Relationship: With friends, with peer groups, superficial or close, own or with the opposite sex;
relationship with relatives and in society.
4. Habits: Food, use of alcohol, tobacco, drugs, disturbed sleep.
5. Occupation, if applicable:
a. Information about present job (if employed or self-employed)
b. Whether he is under stress at work.
c. Information about relationship with colleagues (senior and junior)
d. Skills the client has.
e. Credit facility taken, if any.
Contd...
Supervision, Monitoring and Evaluation of Community-based Rehabilitation 87
Contd...
If unemployed – why? Are there any immediate plans for employment?
6. Present family circumstances:
a. Question on housing – do they own it or rent it?
b. Finances.
c. To understand the client’s circumstances.
d. What aspects of his/her life are stressful and how is the disability affecting him/her.
7. The disability worker may observe the following:
a. To know the personality of the client: General knowledge, wishes, ego, strength, sense of
tolerance, co-operation, sensitivity, adaptability, communication patterns, sympathy, responsibility,
expression of emotions, devotion and motivation to work, level of aspirations and weaknesses
in his personality.
b. To know the mood/character of the client: Cheerful or gloomy, anxious, worrying, over-confident,
sensitive, suspicious, jealous, shy, self-conscious, dependent, rigid etc.
ACTION PLAN
1. Client’s efforts to solve his/her problem Disability Worker/Social Worker should know the efforts made
by the client to deal with his problem; the help taken so far from organizations, agencies and others;
effects of help received; client’s opinion towards these and other agencies and on the help received.
2. Reasons for the present condition of the client and root cause of the disability, as perceived by
the client/informant – whether it is political, biological, psychological or economic.
3. Problematic areas as perceived and agreed upon by the client family members and the Disability/
Social Worker.
4. Analysis by the disability worker of the situation/problem, based on the data / details collected
5. Client’s future plan
a. What does he/she feel and thinks about him/herself?
b. What does he/she want to do and how is he/she planning to achieve this?
c. Whether the family members have any other plans for his/her future?
6. Implementation of Action Plan: What, How, When, Where and by who (made in consultation with
the client and family members?
1.
2.
3.
4.
7. Follow-up action
Source: ADD India (2001) Building Abilities Mr.Ramachandra, Executive Director, ADD India, Action
on Disability and Development (ADD) India 4005 19 Cross, Banashankari II Stage Bangalore 560 070
Publishers: Books for Change – A Unit of ActionAid Karnataka Projects, Skip House, 25/1 Museum
Road Bangalore 560 025
88 Community Based Rehabilitation of Persons with Disabilities
BIBLIOGRAPHY
1. Anita Gibbs, Social Research Update, Department of Sociology, University of Surrey, Guildford GU7 5XH,
England.
2. Identification and Needs Assessment of Beneficiaries in Community Based Rehabilitation Initiatives, Maya
Thomas, S Pruthvish, Monograph, ActionAid India, 1993.
3. Morgan, David L., Focus Groups as Qualitative Research, Sage, Thousand Oaks, CA, 1997.
4. Pauline V Young, Scientific Social Surveys and Research, IV Edition, Prentice Hall of India Private Limited,
New Delhi 1992.
5. Pruthvish S. (1998) “Programme Development in CBR and Resultant Social functioning abilities”, ActionAid
Disability News, Vol. 9, No.1, 1998.
6. Pruthvish S. and Maya Thomas: (1993) Identification and Needs Assessment of Beneficiaries in Community
Based Rehabilitation Initiatives, ActionAid Disability News, Vol. 4, No.1, 1993.
7. Pruthvish S. Maya Thomas, Thomas M. J: (1996), Identification Survey in twelve ActionAid Supported CBR
Projects - A discussion on the prevalence of different Disabilities, ActionAid Disability News, Vol. 7 (1), PP
21-22.
8. Pruthvish S. Maya Thomas, Thomas M. J: (1996), Prevalence of Disability in ActionAid supported CBR Projects
and its significance in Program Planning, ActionAid Disability News, Vol. 7 (1), PP 23-24.
9. Pruthvish, S. and Maya Thomas: (1992), Research in Rehabilitation—Proposed Strategies of Disability Division,
ActionAid Disability News Vol.3, No.2, 1992.
10. Rajendra KR, Application of PRA for Therapeutic Interventions in Disability Rehabilitation, ActionAid Disability
News, Vol 10, No 1 and 2, 1999.
11. Somesh Kumar (2002) PRA.
12. Uma Thuli, Pruthvish S., Maya T homas, Joseph Panarkel (1996), Identification and Needs Assessment at
Amar Jyothi CBR Project - ActionAid Disability News, Vol.7 (1): 16-17.
Resources for CBR
and Disability
9 Rehabilitation
LEARNING OBJECTIVES
• Participants should be able to list resource materials, resource organizations in CBR
• Participants should be able to access resource materials using internet
OUTLINE OF CONTENT
• Summaries of useful resource organizations/projects
• List of reference books, periodicals, journals, slides, video films that will be useful
• List of resource organizations and their work across the country/abroad
• List of useful websites and internet links
SUGGESTED METHODOLOGY
• Sharing list of resource materials/resource organizations
• Visiting resource organizations
• Library work
• Browsing internet
PRE/POST EVALUATION
• List useful resource books/journals in community-based rehabilitation
• List useful organizations/projects undertaking community-based rehabilitation
• Have you accessed useful websites?
17. CHETNA
Sector C, Aliganj Housing Scheme
Lucknow—226 020, Uttar Pradesh
18. Chetna Institute for the Mentally Handicapped
Lakshmi Vihar
Bhubaneshwar—751 005
Orissa
19. Child Development and Research Centre
AD –80, 5th Avenue
Anna Nagar
Chennai—600 040, Tamilnadu
20. Child In Need Institute
Vill. Daulatpur, P.O. Amagachi
Via: Joka
Dist. 24 Paragana (S)
West Bengal—743 512
21. Children’s Orthopaedic Hospital
Haji Ali Park
Clerk Road, Mahalaxmi
Bombay—400 034
Maharashtra
22. Christian Medical College
Dept. of Physical Medicine and Rehabilitation
Vellore
Tamilnadu
23. Deepshikha
70, Circular Road
Opp. Women’s College
Ranchi, Bihar
24. Don Bosco Prem Nivas
Mangalagiri—522 503
Guntur Distt.
Andhra Pradesh
25. Education and Training Institute for Mentally Retarded Children
29/24 Nandanavan Society
Race Course Road
Athwa Lines,
Surat, Gujarat
26. Gandhi Memorial Leprosy Foundation
Hindinagar, Wardha—442 103,
Maharashtra
98 Community Based Rehabilitation of Persons with Disabilities
Funding Support
The national mental health programme for India formulated by the Ministry of Health in
1982 forms the main policy framework for mental health programme. Support can be
obtained from the NMHP funds.
The drug dependence programmes are funded both by the Ministry of health and
Ministry of welfare. The funding is available for counselling centres, detoxification centres
and deaddiction centres, along with training programmes.
The activities related to rehabilitation and suicide prevention are supported by Ministry
of welfare. The support for mental retardation work is also available from ministry of
welfare.
The resource centres available for the above mental health activities are:
1. National Institute of Mental Health and Neuro Sciences,
Post Bag No. 2900,
Bangalore - 560029.
2. National Institute of Mentally Handicapped
Manovikas Nagar.
P.O. Bowenpallv.
Secunderabad - 500011.
3. SANJIVINI
A 6, Institutional Area,
Satsang Vihar Marg,
South of IIT.
New Delhi 110067.
4. Schizophrenia Research Foundation (India),
No. C-46, 13th Street,
East Anna Nagar,
Madras - 600102.
Resources for CBR and Disability Rehabilitation 99
16. Paripurnata
5 B, Maharani Swarnarnoyee Road
Calcutta - 700009
West Bengal.
17. Department of Psychiatry Postgraduate Institute of Medical Education and Research
Chandigarh 160012.
18. Indian Law Institute,
Bhagwandas Road,
New Delhi - 110002.
19. Department of Psychiatry
B.Y.L. Nair Ch. Hospital and T.N. Medical College
Bombay - 8.
20. Department of Psychiatry
S.N. Medical College,
Jodhpur.
21. Institute of Human Behaviour and Allied Sciences
G.T. Road, Shahdara
Delhi - 110095.
22. National Addiction Research Centre
Floor 5, Hardawadi Hospital
Bhardawadi Road, Andheri (W)
Bombay - 400 058.
23. TTR Education Foundation
TTK Hospital
17, IV Main Road
Indira Nagar,
Madras - 600 020.
24. Dr. R.N.Cooper Hospital and
Seth G.S. Medical College
Bombay - 400 056.
25. Mental Health Centre
Christian Medical College and Hospital
Vellore.- 632002
Tamil Nadu.
26. Maharashtra Institute of Mental Health
Sasoon Hospital
Pune,
Maharashtra.
27. Department of Psychiatry
SMS Medical College
Jaipur - 302004.
Rajasthan.
Resources for CBR and Disability Rehabilitation 101
Fellowships
The university grants commission has reserved one percent of the fellowships allocated
to the universities for the disabled persons. In the case of scholars who are visuals disabled.
UGC provides a special grant to cover the appointment of a reader.
102 Community Based Rehabilitation of Persons with Disabilities
In industrial training institutes, state governments have reserved three percent seats
for the handicapped under the craftsmen training programme.
The implementing authorities of the apprenticeship training programme at the centre/
state level have been instructed to identify trades from among the existing 136 trades
designated under the Apprentices Act, 1961 considered suitable for apprenticeship. Training
of the physically handicapped and to place the maximum number of handicapped apprentices
in the establishment concerned so as to achieve the overall target of 3 percent taking all
the establishments in the public and private sectors together.
Employment
Special Employment Exchanges (Ministry of Labour, Administrative Control—State
Governments)
The 22 Special Employment Exchanges provide placement facilities to the physically
handicapped for gainful employment (see list pp109-111).
These exchanges follow selective placement approach through job referral system on
the basis of ability and individualised approach through their family background.
Another function assigned to the special employment officer is escorting the candidates
to the employers for interviews and helping both the employers and handicapped in making
personal and job adjustment thereby achieving full rehabilitation.
Medical boards are attached to these special employment exchanges and nedical
examination of the handicapped person at the time of their appointment is arranged through
these Boards.
Reservations
i. One percent vacancies are reserved for each for the blind, the deaf and the
orthopaedically handicapped with an overall ceiling of 35 in group ‘C’ and ‘D’ posts
in central services and in comparable posts in government of the public sector
undertakings. Priority ill is accorded for submission of candidates by employment
exchanges against central government vacancies for group ‘C’ and ‘D’ posts.
ii. Where the candidates belonging to a particular category of handicapped are not available
or where the nature of work does not technically permit the appointment of a particular
category of handicapped persons interest exchange is allowed.
iii. Where a sufficient number of persons belonging to a given category of the physically
handicapped is not available, the unfilled vacancies will be carried over for a period
upto three recruitment years.
104 Community Based Rehabilitation of Persons with Disabilities
iv. It is the responsibility of each and every employing ministry to identify occupations
that can be practiced without impairing efficiency by various types of physically
handicapped persons with or without the use of special equipment.
v. Physically handicapped persons belonging to the scheduled caste/scheduled tribe are
given preference for recruitment to Group ‘C’ and ‘D’ posts in the public sector
undertakings against the reserve quotas for this category.
vi. To ensure that the physically handicapped persons get the posts reserved for them.
One hundred point Roster is prepared and 34th, 67th and 100th vacancies occurring
in a particular recruitment year are reserved for the blind, the deaf and the
orthopaedically handicapped persons.
Concessions/Relaxations
Age:
i. The upper age limit in the case of blind, deaf and orthopaedically handicapped persons
has been relaxed up to 10 velars for the purpose of appointment of group ‘C’ and ‘D’
posts through the employment exchanges.
ii. Physically handicapped persons belonging to the scheduled castes/scheduled tribes are
(allowed another 5 years over and above the age relaxation admissible to them as
scheduled castes/scheduled tribes.
Physical fitness:
i. Physically handicapped persons are not subjected to the usual medical examination by
the appointing authorities but the report of the medical board attached to the special
employment exchanges for the physically handicapped is sufficient for entry into group
‘C’ and ‘D’ of central government services except in railways.
ii. Medical board may recommend one eyed persons for group ‘A’ and ‘B’ civil posts which
do not require stereoscopic vision or perception of depth, if the Board is satisfied that
the person can perform all the functions of the particular job for which he or she is
a candidate and the visual acuity in the functioning eve is upto the specified standard.
Qualifications: Exemptions is allowed from typing qualification for appointment to clerical
posts if they are found otherwise qualified and certified as being unable to type by the
medical board attached to special employment exchange or by a civil surgeon where there
is no such Board.
Others: Various government of India undertakings like Air India, Indian airlines. Public sector
banks have also extended some concessions/relaxations in upper age limit varying from
5 to 10 years and physical fitness for recruitment to clerical and subordinate cadres.
Other Facilities/Concessions
Travel
a. By Railways: Blind person and mentally handicapped travelling by rail are allowed 75
percent concession in both first and second classes. Wherever they travel along with
Resources for CBR and Disability Rehabilitation 105
an escort both the blind and the escort are allowed 75 percent concession in both first
and second classes.
b. By Roadways: Many of the State Governments offer either full concession or 50 percent
concession for travelling in state run buses. Such facilities are known to have been offered
by Andhra Pradesh, Bihar, Delhi, Goa, Gujarat, Haryana, Himachal Pradesh, Jammu &
Kashmir, Karnataka, Kerala, Maharashtra, Punjab, Tamil Nadu, Tripura, West Bengal
and Uttar Pradesh.
c. By Air: Indian airline allows 50 percent concessional fare to blind persons of single
journey or single fare for round trip journer on all domestic fights. However, escorts
have to pay full fare.
d. Reservation of dealers/agencies of oil companies (Ministry of Petroleum, Chemicals Fertilizers): The
Ministry has decided to earmark 15 percent of all types of dealerships/agencies of the
public sector oil companies for the handicapped persons, including those disabled in war.
Custom Duty
a. Institutions: Institutions for the blind are permitted to import equipment and apparatus
required for education and training of the blind, free of custom duty, if such equipment
and apparatus are received as bona fide gifts. For this purpose, institutions, concerned
are required to obtain a custom clearance permit from chief controller of Imports and
Exports, New Delhi.
b. Individuals: The Central Government exempts certain goods when imported by a blind
person for his personal use from whole of the duty of customs and the additional duty
subject to the condition that the importer produces to the Assistant controller of customs,
as the time of importation, a certificate from the competent authority that the importer
suffers from a particular disability and the imported goods in respect of which the
exemption is claimed are essential to overcome the said disability.
c. Import of audio cassettes from libraries/agencies: Books and magazines recorded on a audio
cassettes are exempted from customs duty when imported from libraries/agencies for
the blind overseas.
d. Preference in housing (Ministry of Works and Housing): Government of India considers the
requests of the blind employees who are eligible for general poor accommodation on
merit. DDA has reserved 5 percent shops. One percent residential plots and 1 percent
flats in each housing scheme for the disabled persons. Many State Governments also
provide out of the turn/reserve some quota of housing accommodation.
106 Community Based Rehabilitation of Persons with Disabilities
Cooperative Sector
Cooperative societies formed by disabled enjoy a variety of concessions ranging from
income-tax to permit to receive institutional quota of newsprint, essential commodities, in
sales-tax, excise duty and octroi. The state departments of social welfare/welfare of the
disabled are authorised to contribute subsidy and loan for purchase of shares in the
cooperative societies. Ultimately, the collector, the district school welfare officer, the deputy
Resources for CBR and Disability Rehabilitation 107
registrar of cooperatives and the subdivisional commissioners are the final authorities to
provide exemptions.
General
Using discretionary powers, the collectors can issue institutional ration card, permission
to levy only commercial rate of electricity, cut down/implify red tape and recommend NGOs
proposal for government grants. Issue income/orphan certificates, permission to use river
sand and other local building material and other useful permits.
Resource Institutions—Government
The New Act —Persons with Disabilities Act, 1995 envisages a number of initiatives at the
central and state levels. It can be expected that there will be greater support opportunities
in future.
In addition, a number of national and international organisations (e.g. ActionAid, 3,
Rest House Road. P.B. No. 5406. Bangalore- 560 001) support work with disabled persons.
1. National Institute for the Mentally Handicapped
Manovikas Nagar, Secunderabad 500 009, Andhra Pradesh
Thakur Ilari Prasad Institute, Dilsukh Nagar, Hyderabad 500 660, Andhara Pradesh
2. The Director
National Institute for the Orthopaedically Handicapped
B.T. Road. Bon-Hooghly Calcutta 700 090.
3. The Director
National Institute for the Visually Handicapped
116 Rajpur Road, Dehradun 248 001. Uttranchal
4. All Yavar Jung National lnstitute forthe Hearing
Handicapped, Bandra (West), Mumbai 400 050
5. National Handicapped Welfare Fund
C/o Ministry of Welfare, Govt. of India. Shastri Bhavan, New Delhi 110001
6. The Director
All India Institute of Physical Medicine
Haji Ali, Mumbai 4000 034.
7. The Director
Advanced Orthopaedic Centre
178 Anoop Nagar. Indore 452 008.
8. Institute for Mentally Handicapped
Bal Bhavan, Golghar Complex, Patna 800 001, Bihar.
9. Rehabilitation Council of India
New Delhi
10. The Director Handicapped Welfare Wing, Ministry of Welfare, Govt. of India, Shastri
Bhavan, New Delhi 110 001
11. The Director State Dept. of Social Welfare/Welfare of Handicapped Capital City
108 Community Based Rehabilitation of Persons with Disabilities
NGOs
1. Manovikas Kendra Purb Sarania, Guwahati 781 001, Assam
2. Mental Retardation Project Under UNICEF, Punjab University, Chandigarh 160 014.
3. The Director, Amar Seva Sangam Ayikudi 627 852 Tirunelveli’ District. Tamil Nadu.
4. The Director, Rayalaseema Selva Samithi 2-2-375A K.V. Layout Tirupathi 517 507, Andhra
Pradesh
5. The Director, Society for the Education of the Crippled Agripada Municipal School
Building Motlihai St, Agripada, Mumbai 400 011.
6. Spastic Society in Allahabad, Bangalore, Mumbai, Delhi, Guwahati, Madras and other
cities.
7. Sri Hiralal Sharma, Ashagram Nimar, Barwani District, Madhya Pradesh
8. The Executive Director, National Association of the Blind, 11 Khan Abdul Gaffar Khan
Road, Mumbai 400 025.
9. All India Confederation of the Blind, Braille Bhavan, Institutional Area, Sector 5, Rohini,
New Delhi 110085
10. The Director
National Federation of the Blind, 2322 Laxmi Narayan Street, Paharganj, New Delhi
110 055
11. The Director
Blind Men’s Association, Dr.Vikram Sarabhai Road, Vastrapur, Ahmedabad 380 015
12. The Director, The Blind Boys Academy, Narendrapur. Dist. Twenty-four Paraganas,
West Bengal 721211.
13. The Director, Kerala Federation of the Blind, Kannukuziuy, Trivandram 695037
14. Amar Jyoti Charitable Trust
Karkar Dooma. Vikas Marg., New Delhi 110 092
15. Samadhan
J-32, South Ext.I, New Delhi 110 049
16. Naval Public School
Vasco da Gama, Goa 403 801
17. B.M. Institute of Mental Health, Ashram Road, Ahmedabad 380 009, Gujarat
18. ADMH Centre for Special-Children
Gotri Road, Baroda 390 007
19. Red Cross Institute for Mental Retarded Children
Gandhi Camp, Rohtak 124 001, Haryana
20. Prem Ashram Children’s Home
Una 174 303, Himachal Pradesh
21. Spastic Society of India
Indira Nagar, Bangalore 560 038
22. Asha Kendram, Model Normalisation Centre for
MR Children, Kerikkamurrv, Cochin 682 001, Kerala
23. Asha Niketan Rehabilitation Pradesh Centre
Arera Colony, Bhopal 462 016, Madhya Pradesh
Resources for CBR and Disability Rehabilitation 109
Legislations
1. Rehabilitation Council of India Act, 1992.
2. The persons with Disability (Security and Rehabilitation) Act, 1996.
3. The Rehabilitation Council of India Act, 1992 for regulating the training of rehabilitation
professionals and the maintenance of a Central Rehabilitation Register has come into
effect from 31.7.1993.
4. The Mental Health Act, 1987.
References
1. Ali Baquer, Disabled Disablement Disablism: Voluntary Health Association of India,
New Delhi, 1994.
2. Bhushan Punani & Nandini Rawal, Hand Book: Vishal Handicap: Ashish Publishing
House, New Delhi –1993.
3. Braille and talking Book Catalouges published in the region.
4. Camp Approach for Rehabilitation of Polio Patients in Rural Areas: Proceedings of the
WHO Seminar held at Lall India Institute of Medical Sciences, Edited by Dr. S.K. Verma,
Dr. U. Singh & Dr. D.K. Taneja, New Delhi 27-28 January, 1991.
5. Community Rehabilitation Programme. A NIMH, Secunderabad publication.
6. David Wener, Disabled Village Children: A guide for community health workers,
rehabilitation workers and families: Voluntary Health Association of India, New Delhi,
1994.
7. Directory of Professionals in Mentally Handicapped in India. A NIMH, Secunderabad
Publication, 1992.
8. Educational Concessions for the Blind, National Association for the Blind, 1991.
9. GOI, Encyclopaedia of Social Work in India: New Delhi, 1987.
10. Indian Guide to Aids and Appliances for the Blind, National Association for the Blind,
1992.
11. Job-analysis and Qn the Job Training for Persons with Mental Retarded-Series. A NIMH,
Secunderabad Publication.
12. Mallick, P.K. Management Training in Total Rehabilitation of Tibarewala, D.N the
Disabled: Calcutta: National Institute for the Orthopaedically Handicapped, 1990.
13. Mane, P. Mental Health in India: Gandevia. KY (ed) Mumbai: TISS, 1993.
14. Mental Retardation, A Manual for Village Rehabilitation Workers. A NIMH,
Secunderabad publication.
15. Organization of Special School for Mentally Retarded Persons. A NIMH, Secunderabad
publication.
16. Programmes and Concessions for the Blind. All India Confederation of the Blind. 1990
114 Community Based Rehabilitation of Persons with Disabilities
17. R.S. Pandey and Lal Advani. Perspectives Perspecives in Disability and Rehabilitation:
Vikas Publishing House Pvt. Ltd., New Delhi, 1995.
18. Webb, J.B. “Society’s Role in Rehabilitation”. Calcutta: Rehabilitation Centre for
Children, 1990.
UN – United Nations
http://www.un.org/esa/socdev/enable
United Nations Special Rapporteur for the Commission for Social Development on Disability
Email : un-spec.rapp@telia.com
UNICEF – United Natins Children Fund
http://www.unicef.org
WHO – World Health Organisation
http://www.who.int/hpr/rhb/index.html
Resources for CBR and Disability Rehabilitation 115
International NGOs
Useful Websites
Heperian Foundation
http://www.hesperian.org
Asia Pacific Disability Rehabilitation Journal
http://www.aifo.it/english/apdrj/apdrj.htm
World Vision
http://wvision.org
World Blind Union
http://www.wbuga.org
Rehabilitation International
http://www.rehab.international.org
Inclusion International
http://www.inclusion-international.org
World Federation of the Deaf
http://www.wed.news.org
The International Dyslexia Association
http://www.interdys.org/index.jsp
www.censusindia.net/disability/disability—map gallery html
116 Community Based Rehabilitation of Persons with Disabilities
BIBLIOGRAPHY
1. ADD India, Building Abilities Books for Change (Publishers) Bangalore, 2001.
2. AHRATAG—Resources in community-based Rehabilitation
3. DAR Unit, WHO, Geneva, list of publications
4. Disability and liberation—OXFAM—Peter Coleridge
5. Disabled village children by David Werner—Hesperian Foundation
6. Harsh Mander Agenda For Caring VHAI, New Delhi, 2000.
10 Legislations
DISABILITY ACT OF 1995 AND OTHER LEGISLATIONS CONCERNING DISABLED
PEOPLE IN INDIA
Excerpts from Disability Act: Status of Implementation; need for advocacy—advocacy at
Individual, Family and Community level; organising disabled people; organising self help
groups, organising parent’s groups;
Other legislations—National Trust Act, Mental Health Act; Indian Factories Act; ESI Act;
Mines Labourer’s Act, Dock Labourer’s Act, etc.
LEARNING OBJECTIVES
• Participants should be able to list provisions under Disability Act of 1995.
• Participants should be able to list important provisions under National Trust Act,
National Mental Health Act, The ESI Act, The Indian Factories Act
• Participants should be able to comprehend the meaning and approaches to advocacy
measures—individual, group, state and country levels.
OUTLINE OF CONTENT
• Details of history of legislations for the disabled, upto UN standard rules
• Details of Disability Act of 1995; machinery for implementation; status of implementation
• Census and Disabled people
• Details of National Trust Act, National Mental Health Act, The ESI Act, The Indian
Factories Act.
SUGGESTED METHODOLOGY
• Lecture—discussion
• Focus group discussion with disabled people
PRE/POST EVALUATION
• What is advocacy?
• What are the contents of UN Standard rules/Disability Act of 1995
118 Community Based Rehabilitation of Persons with Disabilities
In this chapter, the salient features of the Act, the implementation mechanisms, the
magnitude of the problem in India, and the international consensus on the need to redress
the problems of the disabled are dealt with.
examination” of particular significance in the Persons with Disabilities Act in India is the
inclusion of leprosy-cured persons. For people affected by leprosy, mention of them as
separate category represents a triumph for leprosy workers who have in recent years
increasingly advocated for this group to be officially included as a disability group to
facilitate their social and economic rehabilitation as distinct from medical treatment.
The separation of groups who had earlier been treated as belonging to a single category
is also of significance. For example, blind and low vision persons (earlier not distinguished
as being two groups with different needs and abilities); as well as persons with mental
retardation and those with mental illness (earlier treated as being of the same category
of persons with mental disorders).
Since the last two and a half years, we see two major developments. Firstly, there has
been an attempt at the centre and in the states to appoint co-ordination committees. The
central executive committee was constituted almost one and a half years after enactment
and chief commissioners were appointed only recently. Rules have been framed in
government of India notification dated 31 December 1996 for the implementation of the
Act. The rules specifically focus on:
• Guidelines for evaluation and assessment of various disabilities;
• Central co-ordination committee;
• Central executive committee;
• Employment;
• Chief commissioner of persons with disabilities
Regrettably, the committees are yet to meet on a regular basis, understand the terms
of reference and act upon them which means not much has happened after the Act has
been passed. The pace of implementation of the Act is dismally slow. Full-time
commissioners are yet to be appointed in States, and the representation of NGOs and
disabled persons is grossly inadequate both at the centre and the states. In a nutshell, one
can say there is no difference in the quality of life of persons with disability since the
enactment.
Important functions are assigned to the central and state co-ordination committees
though they do not seem to have accomplished much since their formation. Their functions
include:
• Serving as a national/state focal point on disability matters;
• Reviewing and co-ordinating activities of all Government departments, Governmental
Organisations (GOs) and Non-Governmental Organisations (NGOs);
• Developing national policy to address issues faced by disabled persons;
• Advising central government on the formulation of polices, programmes, legislation and
projects with respect to disability;
• Taking steps to ensure a barrier-free environment in public places, work places, public
utilities, schools and other institutions;
• Monitoring and evaluating the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities.
Legislations 121
International Consensus
The International Labour Organisation (ILO), UNESCO and WHO have given a joint
statement endorsing community based rehabilitation as the key approach towards improving
the quality of life of PWD. UNESCAP has established regional interagency committee for
the Asia and Pacific to address disability related concerns. The world programme of action,
declaration of Asian and Pacific decade of disabled persons, the decade’s mandate and
targets for action are important developments towards growing international concern and
consensus towards full participation of disabled persons. We see improved technology and
service delivery mechanisms in Japan and Hong Kong with the intensive involvement of
both government and voluntary sectors.
The Seoul declaration (1997) and the Hong Kong statement (1998) during the conference
of rehabilitation international, campaigns of the regional NGO Network, UNESCAP review
(1997) are important attempts towards international co-operation and consensus.
employment of all persons with disabilities within the limits of the resources. The Act
highlights coordination of NGO and governmental efforts.
Evolution of a comprehensive policy, development of a national CBR plan, human
resources development in CBR, creating a barrier-free environment will make a great deal
of difference to the quality of life of a PWD. There is a need to arrive at detailed rules,
detailed plans and strategies and appropriate budget allocation.
NGOs have been major players in rehabilitation in India. Networking and information
exchange among NGOs, government, and private sector will make a lot of difference in
the implementation of the provisions of the Act. There is a need for understanding of the
Act, collaboration for the ownership, and responsibility for the implementation of the Act
by both government and NGOs. Involvement of corporate sector will definitely contribute
towards improving the quality of life of PWD in our country.
Rehabilitation of persons with disability is cost-intensive and corporate sector
involvement is likely to make a difference. Attempts have been made by ActionAid India
to widen the horizon of choices for PWD through corporate partnerships. These attempts
are either towards programme development (CBR programme) or towards increasing
employment opportunities in the private sector. Collaboration with Titan watches is an
example towards this end.
The Disability Act of 1995 leaves the enforcement of respective provisions to courts of
law without prescribing special summary procedures to be followed in the event of
proceeding under the respective legislation. This makes it difficult for persons with
disabilities, who usually have limited resources and legal knowledge, to participate in
complicated, lengthy and expensive legal processes.
There is need for concerted efforts to be made on information dissemination and raising
public awareness concerning equalization legislation. Public awareness programmes on
various provisions are required which aim at generating understanding among both disabled
and non-disabled citizens in diverse sectors. Such programmes are also needed where there
is general ignorance of the rights of citizens with disabilities. Developing mechanisms and
criteria for regular monitoring, periodic evaluation and strengthening of equalization
legislation using the feedback obtained are needed. The absence of adequate mechanisms,
and criteria for monitoring and evaluation, particularly if compounded by a lack of resource
allocation, means that well drafted legislation with excellent provisions may languish.
APPROACH
ADD works in partnership with local organizations in rural south India. It supports them through training,
review and planning of their work.
Contact Details:
Mr. R. Ramachandran
Executive Director
Action On Disability and Development India
4005. 18th Cross, Banashankari II Stage, Bangalore-560 070
Email: addindia@vsnl.net
BIBLIOGRAPHY
1. Call for Action (ActonAid India, CAPART and NCPEDP).
2. Case Study of effort by Javed Abidi to include disability Question in Census 2001.
3. Government of India, The Persons With Disabilities (Equal Opportunities, Protection of Rights and Full
Participation) Act, 1995, New Delhi, 1995.
4. Model building Rules
5. The ESI Act
Legislations 125
OUTLINE OF CONTENT
• What is vocational rehabilitation?
• What is vocational assessment?
• Employment for disabled people
• How to plan vocational training and employment opportunities for persons with
disabilities?
PRE/POST EVALUATION
• List needs of persons with disability
• List jobs which persons with different disabilities may not be able to do.
• List jobs persons with disabilities will not be able to do
• List vocational training and employment opportunities for persons with disabilities
INTRODUCTION
It is useful recall couple of incidents and experiences while beginning to discuss about
vocational training and employment opportunities for persons with disabilities. I was doing
Vocational Training and Employment of Persons with Disability 127
a survey of persons with disabilities in Cholaimedu slums in Chennai, South India. A middle-
aged lady came and asked me what are you doing here. I explained to her that a disability
survey is being done in the area where persons with disabilities will be listed, their needs
are assessed and appropriate interventions for Medical, Educational and Vocational needs
can be better planned. She had Congenital Talipes Equino Varus Deformity in both limbs.
Looking at her I suggested to her Surgery will make her feet better. She told me—I do
not want surgery. Can you give me a Buffaloe? I can live happily.
I was working as a Medical Officer in a rural area of Kolar District in Karnataka, India—
I found persons with Mental Retardation working as Shepherds, persons with severe
hearing impairment doing masonry work, farming, animal husbandry, all kinds of hard
labor.
Mr. Ramudu, who has severe degree of visual impairment—worked as a community-
based rehabilitation worker in Sourabha community-based rehabilitation Project now runs
a STD booth and has opened a small scale Industry. A lady who is totally blind in a village
use to help the family by lifting 40 buckets of water from a well. Many persons with disability
do self-employment. Javed Abidi who is on wheelchair organized persons with disabilities
across the country in India. He heads National Council for Employment of Persons with
Disabilities in New Delhi, India.
Mr. Prasanna Kumar Pincha, Joint Director of Social Welfare, Government of Assam is
a well-known efficient officer in North-East of India. Mr. Pincha has visual disability.
In a leading public sector company in India, which is highly responsive to the
communities, a large number of people with Hearing Impairment work in Electronic circuit
assembly. It is in Bharath Electronics located in Bangalore, India. Similar picture is observed
in a separate unit supported by Titan watches in Hosur near Bangalore, India.
The combined and coordinated medical, social, educational and vocational measures for
training and retraining an individual to the highest possible level of functional ability are
called rehabilitation.
Restoration of function constitutes medical rehabilitation, restoration of personal dignity
and confidence is focused in psychological rehabilitation; restoration of family and social
relationships constitutes social rehabilitation.
Restoration of capacity to earn a livelihood constitutes Vocational Rehabilitation. Let
us try to examine this issue in depth in this chapter.
Rehabilitation is not extracurricular activity of a doctor/physiotherapist. A
physiotherapists’ job does not end if therapy has helped gaining a particular movement
better/normal. One needs to train/retrain persons with disability “to live and work within
the limits of disability to the hilt of his capacity”.
Skills Training
Skills training are traditionally provided for persons with disabilities in special training
centers. Vocational Rehabilitation centers of Government of India are located all over the
country, many centers run by NGOs also help in skill training. Skill training helps disabled
people compete with able-bodied persons in seeking job. In the vocational training center
for the handicapped in Bangalore, a number of trades have been identified, manuals and
methodology for skill training is developed. Examples of this include book binding, screen
Vocational Training and Employment of Persons with Disability 129
printing, electrician training, mechanic training, plumbing, carpentry, kitchen utensil making,
etc.
In Sourabha community-based rehabilitation project of Sri Ramana Maharishi Academy
for the Blind and Sri Thirumurthy Rural Development Centre near Kanakapura in Bangalore
Rural District, vocational training is offered in areas of animal husbandry, sericulture,
horticulture, farming, poultry keeping, silk weaving, cardboard box making, etc.
A public sector Bank in India—Canara Bank has established vocational training centers
where training will be provided on trades relevant to local communities.
There is a need for rural rehabilitation and rural integration programmes with focus
on rural trades in our country keeping in mind need for addressing 70 percent of the
population of the State.
Production Units
Apprenticeship and working in production units will help make vocational assessment as
well as will help person with disability to compete with able bodied.
Work Trials
Employment exchanges and placement service agencies can plan to provide these
opportunities to both employees and employers. This mechanism has not developed much
in our country.
Job provides self-confidence and dignity. Work builds positive attitudes.
inaccessible transport, lack of assertive devices and support services, low self esteem and
overprotective families, lack of supportive legal environment and lack of policy support.
Lack of education, lack of employable skills, rapidly changing labor markets, employer’s
attitudes and perceptions, lack of access to self-employment opportunities, unfair terms of
employment, higher work related costs and special problems for disabled women and girls
are barriers to employment.
Although persons with disabilities may be unable to do certain things, with willingness
and innovation, the obstacles to meaningful employment are surmountable.
Scheme of Government of India). Interest rate under some of these schemes is also nominal.
Bottleneck is in accessing it.
Self-employment offers unlimited hope and scope. If groups of persons with disabilities
are formed in all villages/slums, opportunities for loans for self-employment are plenty.
This is often not utilized since organization of persons with disabilities, families of persons
with disabilities is still a concept in most of the villages.
Sheltered Employment
In many countries in developing countries, persons with disabilities have opportunities to
work under sheltered environments and are provided boarding, lodging and wages are
subsidized, production norms are kept low. Such opportunities are present in developing
countries only in pockets and are limited to provision of food, clothing, shelter and pocket
money rather than wages.
Few parents and parents’ associations have taken lead in establishing sheltered
employment opportunities in India. If a group of persons with disabilities plan to establish
a production unit, there is scope and opportunity for large amounts of financial support
from Handicapped Welfare Association of States. Often, this is not utilized. It is unfortunate
that only 5 percent of persons with disabilities have utilized facilities or have access to
Government schemes.
Note from the ILO publication “Integrating women and girls with disabilities into
mainstream vocational training—A practical guide” is interesting. It says:
“Traditionally, programmes for persons with disabilities were segregated. If they had
opportunities, they are available in special schools, residential institutions, and vocational
training programmes and even in work places. While such programmes can play a vital
role for severely disabled people, there is serious limitations in vocational training, this
approach.
Segregates people with disabilities and the rest of the society from each other,
perpetuating the problem of isolation for disabled people and lack of awareness for the
rest of the society.
Tends to maintain disability and sex stereotyped training activities, which are often low
paying jobs, such as dress making, hair dressing, basketry, handicrafts, typing and shorthand
132 Community Based Rehabilitation of Persons with Disabilities
(for women), and carpentry, radio-repair, car-repair and electrical work (for men). Can
only address a tiny fraction of the training needs”.
BIBLIOGRAPHY
1. Barbara Murray and Robert Herson (1999) “Job Placement of Job Seekers with Disabilities—Elements of an
effective service “, ILO, Bangkok.
2. Cheyutha 1998-2000, “Empowerment of Persons with Disabilities”, Government of Andhra Pradesh, India.
3. Einar Helander “Prejudice and Dignity” United Nation Development Programme.
4. Foo Galk Sim (1999) “Integrating Women and Girls with disabilities into mainstream.
5. Government of India “The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full
Participation) Act 1995 with Rules 1997”, Law Publishers India Ltd. Allahabad, India.
6. Robert Herson and Barbara Murray (1997) “Assisting Disabled Persons in Finding Employment “ A Practical
Guide, ILO, Bangkok.
7. Suresh C Ahuja “ Vocational Rehabilitation of the disabled” ActionAid Disability News Vol. 9, No. 2, 1998.
8. Vocational Training—A Practical Guide ILO, Bangkok.
Role of Physiotherapists
in Community-based
Rehabilitation of
12 Persons with Disabilities
India lives in villages. There are 6 lakh villages spread across 600 revenue districts in the
country. Each District in India has a population of about 1 to 2 million. About 74 persent
of population lives in rural areas.
About 6 percent live in tribal belt villages. It is estimated that more than 45 million
persons with disabilities are there in India. In urban areas too, one-third of the population
lives in slums. That means there is need to address rehabilitation issues among the poor,
less literate and in areas where transportation facilities are very poor and rehabilitation
manpower is scarce. In this situation, there is need to:
• Take measures to prevent disabilities
• Transfer skill to communities to develop their own rehabilitation programmes
• Ensure utilization of local resources
• Focus efforts on persons with disabilities, families and communities.
ROLE OF A PHYSIOTHERAPIST
Doctors, Physiotherapists, Special Educators have a major role to play in this direction. There
is need to demystify skills so that it should be possible for family member/person with
disability/community member to act as a therapist/doctor/special educator. Hence, the
author visualizes the role of Physiotherapist in a developing country like India as follows:
• Should be able to develop knowledge, attitudes and skills among students to respond
to poverty/literacy/poor rehabilitation resource availability in the communities.
• Should be a counselor to disabled people/their families and communities.
• Should be able to effectively address the medical needs of people with locomotor
disabilities, cerebral palsy and appropriately refer and guide the person with disability
to meet his educational, vocational and social needs.
• Should be able to refer to relevant personnel for addressing needs of persons with other
disabilities too—communication disabilities, mental retardation, and visual disabilities.
• Should be able to identify resources required for people with all disabilities, educational
and vocational opportunities, as coverage is an important area in community-based
rehabilitation. In essence, physiotherapist can be a coordinator of rehabilitation services
wherever he/she is working—rather than an isolated therapist addressing therapy needs.
134 Community Based Rehabilitation of Persons with Disabilities
He/She needs to be a manager. In a country like India where population is large and
rehabilitation manpower is scarce irrespective of his primary role as a Physiotherapist,
Special Educator, Doctor, one needs to be a Rehabilitation manager.
• Physiotherapy skills
• Counseling skills
• Communication skills
• Skills of motivation
• Local language
• Knowledge of local resources
• Skills of networking with Government/Private/NGO organizations
• Skills of quantitative and qualitative research like Participatory Research
• Advocacy skills
• Knowledge of Government welfare schemes for persons with disability
BIBLIOGRAPHY
1. ADD India. “Building Abilities”.
2. David Werner. “Disabled Village Children”,Publication of Healthwrights.
3. David Werner. “Nothing About Us Without Us”. Publication of Healthwrights.
4. Einar Helander. “Prejudice and Dignity” UNDP, New York.
5. Harsh Mander and Vidya Rao. “An agenda for Caring”. Publication of Voluntary Health
Association of India.
6. Maya Thomas and Pruthvish S. “Identification and needs Assessment of Persons with
Disabilities in Community Based/Rehabilitation Initiatives”—Monograph published by
ActionAid India.
7. Peter Coleridge. “Disability, Liberation and Development”. Publication of OXFAM.
8. UNICEF Disability Kit, UNICEF, Nepal.
9. WHO Training in the community for people with disabilities, WHO, Geneva.
Annexures
ANNEXURE I
PRELIMINARY
1. 1. This Act may be called the Persons with Disabilities (Equal Opportunities, Protection
of Rights and Full Participation) Act, 1995.
2. It extends to the whole of India except the State of Jammu and Kashmir.
3. It shall come into force on such date as the Central Government may, by notification,
appoint.
2. In this Act, unless the context otherwise requires -
a. “Appropriate Government” means –
i. In relation to the Central Government or any establishment/wholly or substantially
financed by that Government, or a Cantonment Board constituted under the
Cantonment Act, 1924, the Central Government;
ii. In relation to a State Government or any establishment wholly or substantially
financed by that Government, or any local authority other than a Cantonment
Board, the State Government;
iii. In respect of the Central Coordination Committee and the Central Executive
Committee, the Central Government;
iv. In respect of the State Coordination Committee and the State Executive Committee,
the State Government;
b. “Blindness” refers to a condition where a person suffers from any of the following
conditions, namely:-
i. total absence of sight; or
ii. visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting
lenses; or
iii. limitation of the field of vision subtending an angle of 20 degree or worse;
c. “Central Coordination Committee” means the Central Coordination Committee
constituted under sub-section (1) of section 3;
d. Central Executive Committee” means the Central Executive Committee constituted
under sub-section (1) of section 9;
e. “Cerebral palsy” means a group of non-progressive conditions of a person characterised
by abnormal motor control posture resulting from brain insult or injuries occurring
in the pre-natal, peri-natal or infant period of development;
138 Community Based Rehabilitation of Persons with Disabilities
1. The Central Government shall by notification constitute a body to be known the Central
Coordination Committee to exercise the powers conferred on, and to perform the functions
assigned to it, under this Act.
2. The Central Coordination Committee shall consist of
a. The Minister in charge of the Department of Welfare in the Central Government
Chairperson, ex-officio,
b. The Minister of State in-Charge of the Department of Welfare in the Central
Government, Vice-Chairperson, ex-officio’,
c. Secretaries to the Government of India in-charge of the Department of Welfare,
Education, Woman and Child Development, Expenditure, Personnel, Training and
Public Grievances, Health, Rural Development, Industrial Development, Urban Affair
and Employment, Science and Technology, Legal Affairs, Public Enterprises, Members
ex-officio’,
d. Chief Commissioner, Member, ex-officio’,
e. Chairman Railway Board, Member, ex-officio,
f. Director - General of Labour, Employment and Training, Member, ex-officio,
g. Director, National Council for Educational Research and Training, Member ex-officio’,
h. Three Members of Parliament, of whom two shall be elected by the House of the
People and one by the Council of States, Members;
i. Three persons to be nominated by the Central Government to represent, the ii which
in the opinion of that Government ought to be represented. Members;
j. Directors of the—
i. National Institute for the Visually Handicapped, Dehradun;
ii. National Institute for the Mentally Handicapped, Secundrabad.
iii. National Institute for the Orthopedically Handicapped, Calcutta.
iv. Ali Yawar Jung National Institute for the Hearing Handicapped, Mumbai; Members,
ex-officio’,
k. Four Members to be nominated by the Central Government by rotation to represent
the States and the Union Territories in such manner as may be prescribed by the
Central Government;
Provided that no appointment under this clause shall be made except on the
recommendation of the State Government or, as the case may be, the Union Territory;
l. Five persons as far as practicable, being persons with disabilities, to represent non-
governmental organisations or associations which are concerned with disabilities, to
be nominated by the Central Government, one from each area of disability, Members;
Provided that while nominating persons under this clause, the Central Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
m. Joint Secretary to the Government of India in the Ministry of Welfare dealing with
the welfare of the handicapped, Member, Secretary, ex-officio,
Annexures 141
3. The office of the Member of the Central Coordination Committee shall not disqualify
its holder for being chosen as or for being a Member of either House of Parliament.
4. a. Save as otherwise provided by or under this Act a Member of Central Coordination
Committee nominated under clause (i) or clause (1) of sub-section (2) of section 3
shall hold office for a term of three years from the date of his nomination:
Provided that such a Member shall, notwithstanding the expiration of his term,
continue to hold office until his successor enters upon his office.
b. The term of office of an ex-officio Member shall come to an end as soon as he ceases
to hold the office by virtue of which he was so nominated.
c. The Central Government may if it thinks fit remove any Member nominated under
clause (i) or clause (1) of sub-section (2) of section 3, before the expiry of his term
of office after giving him a reasonable opportunity of showing cause against the same.
d. A Member nominated under clause (i) or clause (1) of sub-section (2) of section 3
may at any time resign his office by writing under his hand, addressed to the Central
Government and the seat of the said Member shall thereupon become vacant.
e. A casual vacancy in the Central Coordination Committee shall be filled by a fresh
nomination and the person nominated to fill the vacancy shall hold office only for
the remainder of the term for which the Member in whose place he was so nominated.
f. A member nominated under clause (i) or clause (1) of sub-section (2) of section 3
shall be eligible for renomination.
g. Members nominated under clause (i) and clause (1) of sub-section (2) of section 3
shall receive such allowances as may be prescribed by the Central Government.
5. No person shall be a Member of the Central Coordination Committee, who
a. Is, or at any time has been, adjudged insolvent or has suspended payment of his
debts or has compounded with his creditors, or
b. Is of unsound mind and stands so declared by a competent court, or
c. Is or has been convicted of an offence which, in the opinion of the Central Government,
involves moral turpitude, or
d. Is or at any time has been convicted of an offence under this Act, or
e. Has so abused in the opinion of the Central Government his position as a Member
as to render his continuance in the Central Coordination Committee detrimental to
the interests of the general public.
f. No order of removal shall be made by the Central Government under this section
unless the Member concerned has been given a reasonable opportunity of showing
cause against the same.
g. Notwithstanding anything contained in sub-section (1) or sub-section (6) of section
4, a Member who has been removed under this section shall not be, eligible for
renomination as a Member.
6. If a Member of the Central Coordination Committee becomes subject to any of the
disqualifications specified in section 5, his seat shall become vacant.
7. The Central Coordination Committee shall meet at least once in every six months and
shall observe such rules of procedure in regard to the transaction of business at its meetings
as may be prescribed by the Central Government.
142 Community Based Rehabilitation of Persons with Disabilities
8. a. Subject to the provisions of this Act, the function of the Central Coordination Committee
shall be to serve as the national focal point on disability matters and facilitate the
continuous evolution of a comprehensive policy towards solving the problems faced
by persons with disabilities.
b. In particular and without prejudice to the generality of the foregoing, the Central
Coordination Committee may perform all or any of the following functions, namely:
i. Review and coordinate the activities of all the Departments of Government and
other Governmental and non-Governmental Organisations which are dealing with
matters relating to persons with disabilities.
ii. Develop a national policy to address issues faced by persons with disabilities:
iii. Advise the Central Government on the formulation of policies, programmes,
legislation and projects with respect to disability;
iv. Take up the cause of persons with disabilities with the concerned authorities and
the international organisations with a view to provide for schemes and projects
for the disabled in the national plans and other programmes and policies evolved
by the international agencies;
v. Review in consultation with the donor agencies their funding policies from the
perspective of their impact on persons with disabilities;
vi. Take such other steps to ensure barrier-free environment in public places, work
places, public utilities, schools and other institutions;
vii. Monitor and evaluate the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities;
viii. To perform such other functions as may be prescribed by the Central Government.
9. 1. The Central Government shall constitute a Committee to be known as the Central
Executive Committee to perform the functions assigned to it under this Act.
2. The Central Executive Committee shall consist of—
i. The Secretary to the Government of India in the Ministry of Welfare, Chairperson,
ex-officio,
ii. The Chief Commissioner, Member, ex-officio,
iii. The Director-General for Health Services, Member, ex-officio,
iv. The Director-General, Employment and Training, Member, ex-officio’,
v. Six persons not below the rank of a Joint Secretary to the Government of India,
to represent the Ministries or Departments of Rural Development, Education,
Welfare, Personnel Public Grievances and Pension, Urban Affairs and Employment,
Science and Technology, Members, ex-officio,
vi. The Financial Advisor, Ministry of Welfare in the Central Government, Member,
ex-officio,
vii. Advisor (Tariff) Railway Board, Member, ex-officio,
viii. Four members to be nominated by the Central Government, by rotation, to represent
the State Governments and the Union Territories in such manner as may be
prescribed by the Central Government;
ix. One person to be nominated by the Central Government to represent the interest,
which in the opinion of the Central Government ought to be represented, Member;
Annexures 143
6. a. Subject to the provisions of this Act, the function of the State Coordination Committee
shall be to serve as the state focal point on disability matters and facilitate the continuous
evolution of a comprehensive policy towards solving the problems faced by persons
with disabilities.
b. In particular and without prejudice to the generality of the foregoing function the
State Coordination Committee may, within the State perform all or any of the following
functions, namely:—
i. Review and coordinate the activities of all the Departments of Government and
other Governmental and non-governmental Organisations which are dealing with
matters relating to persons with disabilities;
ii. Develop a State policy to address issues faced by persons with disabilities;
iii. Advise the State Government on the formulation of policies, programmes,
legislation and projects with respect to disability;
iv. Review, in consultation with the donor agencies, their funding policies from the
perspective of their impact on persons with disabilities;
v. Take such other steps to ensure barrier-free environment in public places, work
places, public utilities, schools and other institutions;
Provided that while nominating persons under this clause, the State Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
vi. Monitor and evaluate the impact of policies and programmes designed for achieving
equality and full participation of persons with disabilities;
vii. To perform such other functions as may be prescribed by the State Government;
7. a. The State Government shall, constitute a committee to be known as the State Executive
Committee to perform the functions assigned to it under this Act.
b. The State Executive Committee shall consist of—
i. The Secretary, Department of Social Welfare, Chairperson, ex-officio,
ii. The Commissioner, Member, ex-officio,
iii. Nine persons not below the rank of a Joint Secretary to the State Government,
to represent the Departments of Health. Finance, Rural Development, Education,
Welfare,
Personnel Public Grievances, Urban Affairs, Labour and Employment, Science
and Technology, Members ex-officio;
iv. One person to be nominated by the State Government to represent the interest,
which in the opinion of the State Government ought to be represented. Member;
v. Five persons, as far as practicable being persons with disabilities, to represent
non-governmental organisations or associations which are concerned with
disabilities, to be nominated by the State Government, one from each area of
disability. Members;
Provided that while nominating persons under this clause, the State Government
shall nominate at least one woman and one person belonging to Scheduled Castes
or Scheduled Tribes;
Annexures 147
vi. Joint Secretary dealing with the disability division in the Department of Welfare,
Member-Secretary, ex officio,
c. Members nominated under clause (d) or clause (e) of sub-section (2) shall receive
such allowances as may be prescribed by the State Government.
d. A Member nominated under clause (d) or clause (e) may at any time resign his office
by writing under his hand addressed to the State Government and the seat of the
said Member shall thereupon become vacant.
8. a. The State Executive Committee shall be the executive body of the State Coordination
Committee and shall be responsible for carrying out the decisions of the State
Coordination Committee.
b. Without prejudice to the provisions of sub-section (1) the State Executive Committee
shall also perform such other function as may be delegated to it by the State Coordination
Committee.
9. The State Executive Committee shall meet at least once in three months and shall observe
such rules of procedure in regard to the transaction of business at its meetings as may
be prescribed by the State Government.
10. a. The State Executive Committee may associate with itself in such manner and for such
purposes as may be prescribed by the State Government any person whose assistance
or advice it may desire to obtain in performing any of its functions under this Act.
b. A person associated with the State Executive Committee under sub-section (1) for
any purpose shall have the right to take part in the discussions of the State Executive
Committee relevant to that purpose, but shall not have a right to vote at a meeting
of the said Committee and shall not be a member for any other purpose.
c. A persons associated with the said Committee under sub-section (1) for any purpose
shall he paid such fees and allowances, for attending its meetings and for attending
to any other work of the said Committee, as may be prescribed by the State
Government.
11. In the performance of its functions under this Act.—
a. the Central Coordination Committee shall be bound by such directions in writing,
as the Central Government may give to it; and
b. the State Coordination Committee shall be bound by such directions in writing, as
the Central Coordination Committee or the State Government may give to it:
Provided that where a direction given by the State Government is inconsistent
with any direction given by the Central Coordination Committee, the matter shall
be referred to the Central Government for its decision.
12. No act or proceeding of the Central Coordination Committee, the Central Executive
Committee, a State Coordination Committee or a State Executive Committee shall be
called in question on the ground merely on the existence of any vacancy in or any defect
in the constitution of such Committees:
148 Community Based Rehabilitation of Persons with Disabilities
1. Within the limits of their economic capacity and development, the appropriate
Governments and the local authorities, with a view to preventing the occurrence of
disabilities, shall
a. Undertake or cause to be undertaken surveys, investigations and research concerning
the cause of occurrence of disabilities.
b. Promote various methods of preventing disabilities;
c. Screen all the children at least once in a year for the purpose of identifying “at-risk”
cases:
d. Provide facilities for training to the staff at the primary health centers;
e. Sponsor or cause to be sponsored awareness campaigns and disseminate or cause
to be disseminated information for general hygiene, health and sanitation;
f. Take measures for pre-natal, and post-natal care of mother and child;
g. Educate the public through the pre-schools, schools, primary health centres, village
level workers and anganwadi workers;
h. Create awareness amongst the masses through television, radio and other mass media
on the causes of disabilities and the preventive measures to be adopted.
Annexures 149
EDUCATION
EMPLOYMENT
6. a. Every employer shall maintain such record in relation to the person with disability
employed in his establishment in such form and in such manner as may be prescribed
by the appropriate Government.
b. The records maintained under sub-section (1) shall be open to inspection at all reasonable
hours by such persons as may be authorised in this behalf by general or special order
by the appropriate Government.
7. a. The appropriate Governments and local authorities shall by notification formulate
schemes for ensuring employment of persons with disabilities, and such schemes may
provide for—
• the training and welfare of persons with disabilities;
• the relaxation of upper age limit;
• regulating the employment;
• health and safety measures and creation of a non-handicapping environment in
places where persons with disabilities are employed;
• the manner in which and the persons by whom the cost of operating the schemes
is to be defrayed; and
• constituting the authority responsible for the administration of the scheme.
8. All Government educational institutions and other educational institutions receiving aid
from the Government, shall reserve not less than three percent seats for persons with
disabilities.
9. The appropriate Governments and local authorities shall reserve not less than three percent
in all poverty alleviation schemes for the benefit of persons with disabilities.
10. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide incentives to employers both in public and
private sectors to ensure that at least five percent of their workforce is composed of
persons with disabilities.
Annexures 153
AFFIRMATIVE ACTION
1. The appropriate Governments shall by notification make schemes to provide aids and
appliances to persons with disabilities.
2. The appropriate Governments and local authorities shall by notification frame schemes
in favour of persons with disabilities, for the preferential allotment of land at confessional
rates for—
a. House;
b. Setting up business;
c. Setting up of special recreation centres;
d. Establishment of special schools;
e. Establishment of research centres;
f. Establishment of factories by entrepreneurs with disabilities.
154 Community Based Rehabilitation of Persons with Disabilities
NON-DISCRIMINATION
1. Establishments in the transport sector shall, within the limits of their economic capacity
and development for the benefit of persons with disabilities, take special measures to—
a. adapt rail compartments, buses, vessels and aircrafts in such a way as to permit easy
access to such persons;
b. adapt toilets in rail compartments, vessels, aircrafts and waiting rooms in such a way
as to permit the wheel chair users to use them conveniently.
2. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide for—
a. installation of auditory signals at red lights in the public roads for the benefit of
persons with visually handicap;
b. causing curb cuts and slopes to be made in pavements for the easy access of wheel
chair users;
c. engraving on the surface of the zebra crossing for the blind or for persons with low
vision;
d. engraving on the edges of railway platform for the blind or for persons with low
vision;
e. devising appropriate symbols of disability;
f. warning signals at appropriate places.
3. The appropriate Governments and the local authorities shall, within the limits of their
economic capacity and development, provide for—
a. ramps in public buildings;
b. adaptation of toilets for wheel chair users;
c. braille symbols and auditory signals in elevators or lifts;
d. ramps in hospitals, primary health centres and other medical care and rehabilitation
institutions;
4. a. 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 suitable post is available or he attains
the age of superannuating, whichever is earlier.
b. No promotion shall be denied to a person merely on the ground of his disability.
Provided that the appropriate Government may, having regard to the type of
work carried on in any establishment, by notification and subject to such conditions,
if any, as may be specified in such notification, exempt any establishment from the
provisions of this section.
Annexures 155
1. The appropriate Governments and local authorities shall promote and sponsor research,
inter alia, in the following areas —
a. Prevention of disability;
b. Rehabilitation including community based rehabilitation;
c. Development of assistive devices including their psycho-social aspects;
d. Job identification;
e. On site modification in offices and factories;
2. 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 research for special education, rehabilitation and manpower
development.
156 Community Based Rehabilitation of Persons with Disabilities
1. The State Government shall appoint any authority as it deems fit to be a competent
authority for the purposes of this Act.
2. Save as otherwise provided under this Act, no person shall establish or maintain any
institution for persons with disabilities except under and in accordance with a certificate
of registration issued in this behalf by the competent authority:
Provided that a person maintaining an institution for persons with disabilities
immediately before the commencement of this Act may continue to maintain such institution
for a period of six months from such commencement and if he has made an application
for such certificate under this section within the said period of six months, till the disposal
of such application.
3. a. Every application for a certificate of registration shall be made to the competent
authority in such form and in such manner as may be prescribed by the State
Government.
b. On receipt of an application under sub-section (7), the competent authority shall make
such enquiries as it may deem fit and where it is satisfied that the applicant has complied
with the requirements of this Act and the rules made thereunder it shall grant a
certificate of registration to the applicant and where it is not so satisfied the competent
authority shall, by order, refuse to grant the certificate applied for:
Provided that before making any order refusing to grant a certificate the competent
authority shall give to the applicant a reasonable opportunity of being heard and
every order of refusal to grant a certificate shall be communicated to the applicant
in such manner as may be prescribed by the State Government.
c. No certificate of registration shall be granted under sub-section (2) unless the institution
with respect to which an application has been made is in a position to provide such
facilities and maintain such standards as may be prescribed by the State Government.
d. A certificate of registration granted under this section,—
i. shall, unless revoked under section 53, remain in force for such period as may
be prescribed by the State Government.
ii. may be renewed from time to time for a like period; and
iii. shall be in such form and shall be subject to such conditions as may be prescribed
by the State Government.
iv. An application for renewal of a certificate of registration shall be made not less
than sixty days before the period of validity.
v. The certificate of registration shall be displayed by the institution in a conspicuous
place.
4. a. The competent authority may, if it has reasonable cause to believe that the holder
of the certificate of registration granted under sub-section (2) of section 52 has—
i. made a statement in relation to any application for the issue or renewal of the
certificate which is incorrect or false in material particulars; or
Annexures 157
ii. committed or has caused to be committed any breach of rules or any conditions
subject to which the certificate was granted, it may, after making such inquiry,
as it deems fit, by order, revoke the certificate:
Provided that no such order shall be made until an opportunity is given to
the holder of the certificate to show cause as to why the certificate should not
be revoked.
b. Where a certificate in respect of an institution has been revoked under sub-section
(1), such institution shall cease to function from the date of such revocation:
Provided that where an appeal lies under section 54 against the order of revocation,
such institution shall cease to function—
i. where no appeal has been preferred immediately on the expiry of the period
prescribed for the filing of such appeal, or
ii. where such appeal has been preferred, but the order of revocation has been upheld,
from the date of the order of appeal.
c. On the revocation of a certificate in respect of an institution, the competent authority
may direct that any person with disability who is an inmate of such institution on
the date of such revocation, shall be—
i. restored to the custody of her or his parent, spouse or lawful guardian, as the
case may be, or
ii. transferred to any other institution specified by the competent authority.
d. Every institution which holds a certificate of registration which is revoked under
this section shall, immediately after such revocation, surrender such certificate to the
competent authority.
5. a. Any person aggrieved by the order of the competent authority refusing to grant a
certificate or revoking a certificate may, within such period as may be prescribed
by the State Government, prefer an appeal to that Government against such refusal
or revocation.
b. The order of the State Government on such appeal shall be final.
6. Nothing contained in this Chapter shall apply to an institution for persons with disabilities
established or maintained by the Central Government or a State Government.
158 Community Based Rehabilitation of Persons with Disabilities
1. The appropriate Government may establish and maintain institutions for persons with
severe disabilities at such places as it thinks fit.
a. Where, the appropriate Government is of opinion that any institution other than an
institution, established under sub-section (1), is fit for the rehabilitation of the persons
with severe disabilities, the Government may recognise such institution as an institution
for persons with severe disabilities for the purposes of this Act:
Provided that no institution shall be recognised under this section unless such
institution has complied with the requirements of this Act and the rules made
thereunder.
b. Every institution established under sub-section (1) shall be maintained in such manner
and satisfy such conditions as may be prescribed by the appropriate Government.
c. For the purposes of this section “person with severe disability” means a person with
eighty percent or more of one or more disabilities.
Annexures 159
1. a. The Central Government may by notification, appoint a Chief Commissioner for persons
with disabilities for the purposes of this Act.
b. A person shall not be qualified for appointment as the Chief Commissioner unless
he has special knowledge or practical experience in respect of matters relating to
rehabilitation.
c. The salary and allowances payable to and other terms and conditions of service
(including pension, gratuity and other retirement benefits) of the Chief Commissioner
shall be such as may be prescribed by the Central Government.
d. The Central Government shall determine the nature and categories of officers and
other employees required to assist the Chief Commissioner in the discharge of his
functions and provide the Chief Commissioner with such officers and other employees
as it thinks fit.
e. The officers and employees provided to the Chief Commissioner shall discharge their
functions under the general superintendence of the Chief Commissioner.
f. The salaries and allowances and other conditions of service of officers and employees
provided to the Chief Commissioner shall be such as may be prescribed by the Central
Government.
2. The Chief Commissioner shall—
a. coordinate the work of the Commissioners;
b. monitor the utilisation of funds disbursed by the Central Government;
c. take steps to safeguard the rights and facilities made available to persons with
disabilities;
d. submit reports to the Central Government on the implementation of the Act at such
intervals as that Government may prescribe.
3. Without prejudice to the provisions of section 58 the Chief Commissioner may on his
own motion or on the application of any aggrieved person or otherwise look into complaints
with respect to matters relating to—
a. deprivation of rights of persons with disabilities;
c. non-implementation of laws, rules, bye-laws, regulations, executive orders, guidelines
or instructions made or issued by the appropriate Governments and the local authorities
for the welfare and protection of rights or persons with disabilities, and take up the
matter with the appropriate authorities.
4. a. Every State Government may, by notification appoint a Commissioner for persons
with disabilities for the purpose of this Act.
b. A person shall not be qualified for appointment as a Commissioner unless he has
special knowledge or practical experience in respect of matters relating to rehabilitation.
c. The salary and allowances payable to and other terms and conditions of service
(including pension, gratuity and other retirement benefits) of the Commissioner shall
be such as may be prescribed by the State Government.
160 Community Based Rehabilitation of Persons with Disabilities
d. The State Government shall determine the nature and categories of officers and other
employees required to assist the Commissioner in the discharge of his functions and
provide the Commissioner with such officers and other employees as it thinks fit.
e. The officers and employees provided to the Commissioner shall discharge their
functions under the general superintendence of the Commissioner.
f. The salaries and allowances and other conditions of service of officers and employees
provided to the Commissioner shall be such as may be prescribed by the State
Government.
5. The Commissioner within the State shall—
a. coordinate with the departments of the State Government for the programmes and
schemes for the benefit of persons with disabilities;
b. monitor the utilisation of funds disbursed by the State Government;
c. take steps to safeguard the rights and facilities made available to persons with
disabilities;
d. submit reports to the State Government on the implementation of the Act at such
intervals as that Government may prescribe and forward a copy thereof to the Chief
Commissioner.
6. Without prejudice to the provisions of section 61 the Commissioner may on his own
motion or on the application of any aggrieved person or otherwise look into complaints
with respect to matters relating to—
a. deprivation of rights of persons with disabilities;
b. non-implementation of laws, rules, bye-laws, regulations, executive orders, guidelines
or instructions made or issued by the appropriate Governments and the local authorities
for the welfare and protection of rights of persons with disabilities, and take up the
matter with the appropriate authorities.
7. a. The Chief Commissioner and the Commissioners shall, for the purpose of discharging
their functions under this Act, have the same powers as are vested in a court under
the Code of Civil Procedure, 1908 while trying a suit, in respect of the following
matters, namely:—
i. summoning and enforcing the attendance of witnesses;
ii. requiring the discovery and production of any document;
iii. requisitioning any public record or copy thereof from any court or office;
iv. receiving evidence on affidavits; and
v. issuing commissions for the examination of witnesses or documents.
b. Every proceeding before the Chief Commissioner and Commissioners shall be a judicial
proceeding within the meaning of sections 193 and 228 of the Indian Penal Code and
the Chief Commissioner, the Commissioner, the competent authority, shall be deemed
to be a civil court for the purposes of section 195 and Chapter XXVI of the Code
of Criminal Procedure, 1973.
8. a. The Chief Commissioner shall prepare in such form and at such time for each financial
year as may be prescribed by the Central Government an annual report giving a full
account of his activities during the previous financial year and forward a copy thereof
to the Central Government.
Annexures 161
b. The Central Government shall cause the annual report to be laid before each House
of Parliament along with the recommendations explaining the action taken or proposed
to be taken on the recommendation made therein so far as they relate to the Central
Government and the reasons for non-acceptance, if any, of any such recommendation
or part.
9. a. The Commissioner shall prepare in such form and at such time for each financial year
as may be prescribed by the State Government an annual report giving a full account
of his activities during the previous financial year and forward a copy thereof to
the State Government.
b. The State Government shall cause the annual report to be laid before each State
Legislature along with the recommendations explaining the action taken or proposed
to be taken on the recommendation made therein in so far as they relate to the State
Government and the reasons for non-acceptance, if any, of any such recommendation
or part.
162 Community Based Rehabilitation of Persons with Disabilities
SOCIAL SECURITY
1. a. The appropriate Governments and the local authorities shall within the limits of their
economic capacity and development undertake or cause to be undertaken rehabilitation
of all persons with disabilities.
b. For purpose of sub-section (1), the appropriate Governments and local authorities
shall grant financial assistance to non-governmental organisations.
c. The appropriate Governments and local authorities while formulating rehabilitation
policies shall consult the non-governmental organisations working for the cause of
persons with disabilities.
2. a. The appropriate Government shall by notification frame an insurance scheme for the
benefit of its employees with disabilities.
b. Notwithstanding anything contained in this section, the appropriate Government may
instead of framing an insurance scheme frame an alternative security scheme for its
employees with disabilities.
3. The appropriate Governments shall within the limits of their economic capacity and
development shall by notification frame a scheme for payment of an unemployment
allowance to person with disabilities registered with the Special Employment Exchange
for more than two years and who could not be placed in any gainful occupation.
Annexures 163
MISCELLANEOUS
1. Whoever, fraudulently avails or attempts to avail, any benefit meant for persons with
disabilities, shall be punishable with imprisonment for a term which may extend to two
years or with fine which may extend to twenty thousand rupees or with both.
2. The Chief Commissioner, the Commissioners and other officers and staff provided to
them shall be deemed to be public servants within the meaning of section 21 of the Indian
Penal Code.
3. No suit, prosecution or other legal proceeding shall lie against the Central Government,
the State Governments or the local authority or any officer of the Government in respect
of anything which is done in good faith or intended to be done in pursuance of this
Act and any rules or orders made thereunder.
4. The provisions of this Act, or the rules made thereunder shall be in addition to, and
not in derogation of any other law for the time being in force or any rules, order or
any instructions issued thereunder, enacted or issued for the benefit of persons with
disabilities.
5. a. The appropriate Government may, by notification, make rules for carrying out the
provisions of this Act.
b. In particular, and without prejudice to the generality of the foregoing powers, such
rules may provide for all or any of the following matters, namely:—
i. the manner in which a State Government or a Union territory shall be chosen
under clause (k) of sub-section (2) of section 3;
ii. allowances which members shall receive under sub-section (7) of section 4;
iii. rules of procedure which the Central Coordination Committee shall observe in
regard to the transaction of business in its meetings under section 7.
iv. such other functions which the Central Coordination Committee may perform
under clause (h) of sub-section (2) of section 8;
v. the manner in which a State Government or a Union territory shall be chosen
under clause (h) or sub-section (2) of section 9;
vi. the allowances which the Members shall receive under sub-section (3) of section
9.
vii. rules of procedure which the Central Executive Committee shall observe in regard
to transaction of business at its meetings under section II;
viii. the manner and purposes for which a person may be associated under sub-section
(1) of section 12;
ix. fee and allowances which a person associated with the Central Executive Committee
shall receive under sub-section (3) of section 12;
x. allowances which members shall receive under sub-section (7) of section 14;
xi. rules of procedure which a State Coordination Committee shall observe in regard
to transaction of business in its meetings under section 17;
xii. such other functions which a State Coordination Committee may perform under
clause
164 Community Based Rehabilitation of Persons with Disabilities
• the form and time in which annual report shall be prepared under sub-section
(1) of section 65;
• any other matter which is required to be or may be prescribed.
3. Every notification made by the Central Government under the provision to section 33,
proviso to sub-section (2) of section 47, every scheme framed by it under section 27,
section 30, sub-section (1) of section 38, section 42, section 43, section 67, section 68 and
every rule made by it under sub-section (1), shall be laid, as soon as may be after it
is made, before each House of Parliament, while it is in session for a total period of
thirty days which may be comprised in one session or in two or more successive sessions,
and if, before the expiry of the session immediately following the session or the successive
sessions aforesaid, both Houses agree in making any modification in the rule, notification
or scheme, both houses agree that the rule, notification or scheme should not be made,
the rule, notification or scheme shall thereafter have effect only in such modified form
or be of no effect, as the case may be; so, however, that any such modification or annulment
shall be without prejudice to the validity of anything previously done under that rule,
notification or scheme, as the case may be.
4. Every notification made by the State Government under the provision to section 33,
proviso to sub-section (2) of section 47, every scheme made by it under section 27, section
30, sub-section (1) of section 38, section 42, section 43, section 67, section 68 and every
rule made by it under sub-section (1), shall be laid, as soon as may be after it is made,
before each House of State Legislature, where it consists of two Houses or where such
legislature consists of one House before that House.
Source: Government of India, Gazette Notification.
166 Community Based Rehabilitation of Persons with Disabilities
ANNEXURE II
It requires 2-3 hours to fill up performae 1 and 2 in each slum/village. Proforma 3 requires
8-10 minutes per household and appendix to 3 requires 30-40 minutes per disabled person.
Field activities need to be planned keeping in mind the following:
1. Number of slums/villages/tribal colonies in the project area with a breakdown of the
number of households in each of them.
168 Community Based Rehabilitation of Persons with Disabilities
2. Geographical terrain and distance between the villages/tribal colonies/slums, and the
project headquarters.
3. Transport facilities available.
4. Number of personnel available for conduct of the survey and their training.
Field practice can begin slowly, with one enumerator interviewing a family whilst the
other observes. This is one way of overcoming reticence and learning from one another’s
mistakes. As their confidence and skill levels increase, the staff can interview families on
their own, under supervision of the survey co-ordinator.
Enumerators need to visit each house in the cluster and keep a careful record of those
that are unoccupied, do not have disabled persons, or have disabled persons who are not
present at that time or where parents refuse to co-operate. Such data are important in
evaluating results for bias. If large numbers of families with disabled persons are away
in the fields or refuse to co-operate, it is reasonable to surmise that their characteristics
and risk of disability might be different from those of families that were interviewed.
If the houses are found locked, repeat visits should be made either early in the morning
or late in the evening (depending on the occupation of the local people). Information can
be collected from neighbours if repeat visits also fail.
After completing proforma 3 covering all house-holds, the numerator can later assemble
them at a central point.
Uniform case definitions are to be used by all the enumerators.
If cases of leprosy are identified, they should be referred to a nearby Government health
facility. Cured/arrested cases of leprosy with physical deformities may be referred for
rehabilitation on a case by case basis as the project deems fit.
If persons with epilepsy are identifieds they should be referred to a nearby Government
health facility for treatment. Disabilities that might have resulted from untreated epilepsy
may also be considered for rehabilitation.
The supervisors must check the accuracy of the enumerators be reinterviewing at least
10% of households, checking the need assessment of all disabled beneficial and participating
in the analysis of data. All forms should be reviewed at least twice for legibility, accuracy
and completion before entry into the computer (if available). Compute entry should be checked
by special edit programmes. Interview techniques should be standardized and poor quality
unenthusiastic workers must be replaced.
It is advisable to devote one day per week for data entry into master chart so that data
collection and compilation end almost simultaneously.
ANALYSIS OF DATA
Proforma 1 and 2
A summary report must be prepared for each slum/village and a consolidated report
compiled therefrom. The report should specifically touch upon:
1. Facilities of health, formal, informal and special education, vocational training, job
placement/self employment that are locally available.
Annexures 169
2. Other organisations (Government and NGO) working in the area with whom collaboration
is possible.
3. Leaders who could be involved to generate community involvement and participation
in community-based rehabilitation work.
4. Approximate number of disabled beneficiaries.
Proforma 3
Information collected in Proforma 3 (and its appendix) is to be analysed using the following
output tables:
1. Age and sex distribution of the whole population and disabled beneficiaries (disability
wise) for the unit population (village/slum/tribe) and for the whole project area.
2. Religion distribution for the unit population and total population.
3. Caste/ethnic group distribution of the unit population and total population.
4. Nature of occupation for the unit population and total population.
5. Distribution of population according to certain material assets.
6. Consolidated list of beneficiaries according to disability, for the unit population and for
the whole project area.
7. Results of preliminary needs assessment according to disability, for the unit population
and the whole project area.
The primary aim of using Proforma 3 is to identify disabled beneficiaries and to make
a preliminary needs assessment. It is then intended to make correlations with other
information collected. The output tables referred to help in analysis. These are the minimal
output tables from each project and depending on availability of local resources, manpower
and computers, other information collected in the Appendix to proforma 3 can also be analysed
and presented as part of the report. Some of the information collected in the proformae
may not be relevant for immediate use, but might be required at a later date.
INTERVENTIONS
Undertaking identification and preliminary needs assessment survey ultimately helps project
partners in making a Community Diagnosis the problem of disability. Once this is complete,
intervention needs to be planned in consultation with the project co-ordinator and experts
for each disabled person identified. A Community Diagnosis helps in proper budgetary
expenditure and makes the best use of available resources. The first step towards intervention
will be the detailed assessment of individual beneficiaries.
During the identification survey one might identify cases of epilepsy and perhaps also
witness an attack. In such an event, the following tips will be helpful:
• If the person falls down, let the fit run its course.
• Be calm and advise the others nearby not to be frightened.
• It is not necessary to move the person unless he is in the way of traffic or close to fire
or water.
• Fold a cloth and put it under the person’s head.
• Loosen any tight clothing.
170 Community Based Rehabilitation of Persons with Disabilities
When the unusual movements have stopped, turn the person on to his side so that the
tongue falls forward. Any saliva that is collected will flow out of his mouth, making it
easier the person to breathe.
Stay with the person for sometime after the fit is over and comfort him. You may have
to explain to him what has happened since at times he may not be aware that he has had
a fit. He will be tired and may sleep for sometime.
The person should then be referred to a Government facility for initiating treatment.
Q. Nos. 41(1) To understand the current status of intervention for disability in the
46(2) community.
Q. Nos. 42(1) To determine the expectations of the community, to make the community
47(2) understand the limitations of the organisation and to guide the community.
Q. Nos. 43(1) To identify and explore community resources for community-based
49(2) rehabilitation activities.
A secondary school teacher conversant in the local language should be identified to review
translation work or to undertake translation work of the Proformae. It is important to ensure
“meaningful” translation rather than just transliteration.
Often, with the key informants, it may be possible to get an idea of the magnitude of
the problem before planning formal identification of beneficiaries. This also helps to involve
the community in the process. In some situations, key informant survey can be a substitute
for a door to door identification survey in rural settings.
PROFORMA - 3 One proforma for each household
Q. No. l7(V) To enquire whether persons with locomotor disability using wheelchairs
or aids and appliances can move freely in the home environment without
physical barriers.
Q. No. 18 Information collected will be approximate.
Q. No. 25 It will be difficult to record height (total length of the body) in the
case of severe locomotor disabilities. In such a situation, height may
be left unrecorded.
Q. No. 46 To understand hardship because of disability.
Q. No. 54 To comprehend social factors in the family having a bearing on
interventions for the disabled person. Inferences will have to be derived
later by indirect questions, observation and analysis.
Q. No. 56 To study aptitude for vocational training/job placement/self
employment for disabled persons.
Q. No. 57 To facilitate initial assessment and planning a time schedule of activities.
BIBLIOGRAPHY
1. Pruthvish S. and Thomas M. “Identification and Needs Assessment of Beneficiaries in Community Based
Rehabilitation Initiatives” Actionaid Disability News. 1993;4:1.
2. Sommer A. “Field guide to the detection and control of xerophthalmia” WHO, Geneva, 1982.
172 Community Based Rehabilitation of Persons with Disabilities
PROFORMA 1
2.
3.
4.
5.
6.
7.
8.
9.
d. Sikh _____________
e. Others _____________
14. Most common cast/ethnic groups in the slum:
a. _____________
b. _____________
c. _____________
15. Availability of public or private transport from slum to the project post:
(a) Anganawadi
(b) Balawadi
(c) Adult education
centres
(d) Primary School
(e) Secondary School
(f) Junior College
(g) Degree College
(h) Technical Institutes
(i) Special Schools
(j) Others, (Specify)
174 Community Based Rehabilitation of Persons with Disabilities
36. What is the most pressing need of the population in the slum?
37. List the names of the leaders/municipal council member/past council members, other
formal and informal leaders in the slums:
Name Designation
1.
2.
3.
4.
5.
38. List the names of the non-governmental organization/formal and non-formal groups
in the slum:
2.
3.
4.
5.
6.
39. Tick the existing facilities in the slum (or nearby) which have potential for vocational
training:
a. Beedi rolling ( )
b. Agarbathi (incense stick) making ( )
c. Making baskets, mats ( )
d. Making papads/condiments ( )
e. Tailoring ( )
f. Construction work ( )
Annexures 177
g. Power looms ( )
h. Handlooms ( )
i. Printing ( )
j. Fruit vending/vegetable vending ( )
k. Dairy ( )
l. Poultry ( )
m. T.V. Repair/Radio Repair ( )
n. Others (Specify) ( )
40. If possible, please collect the following information:
a. Does anybody in your slum have difficulty
to see (visual impairment) Yes/No
to read (visual impairment) Yes/No
to hear (speech and hearing disabilities) Yes/No
to talk (speech and hearing disabilities) Yes/No
to stand (locomotor disabilities) Yes/No
to walk (locomotor disabilities) Yes/No
to kneel (locomotor disabilities) Yes/No
b. Does anybody in your slum have
history of fits (epilepsy) Yes/No
History of strange behaviour (mental illness) Yes/No
c. Does anybody in your slum have inability to understand what
they see/hear/touch/smell/taste (mental retardation) Yes/No
and/or
Responds slowly to what others say and to what
happens in their surroundings (mental retardation. Yes/No
d. Does anybody in you slum have Hansen’s disease (Leprosy) Yes/No
e. Any other persons with problems related to disability not
listed above Yes/No
41. If you know of persons with disability in the slum, tick the activities that have taken
place/are taking place for their welfare. (The interviewer should explain the following
items to the persons being interviewed in order to elicit the appropriate information.
1. Identification of disabled persons ( )
2. Assessment of disabled persons ( )
3. Medical/surgical treatment ( )
4. Physiotherapy ( )
5. Speech therapy ( )
6. Vocational training ( )
7. Job placement ( )
8. Admission to normal or special schools ( )
9. Use of aids and appliances ( )
10. Others (Specify) ( )
178 Community Based Rehabilitation of Persons with Disabilities
42. With respect of welfare of disabled persons, what does the community expect from the
organization?
43. What services can the community extend to support the organization in delivering
services?
_________________
_________________
Signature of Interviewers
Annexures 179
PROFORMA 2
3.
4.
5.
6.
7.
8.
16. Availability of public or private transport from village to the project post:
(a) Bus
(b) Train
(c) Tempo
(d) Autorickshaw
(b) Balawadi
(c) Adult education
centres
(d) Primary School
(c) Pond/Tank
(d) River
41. What is the most pressing need of the population in the community?
42. List the names of the leaders/municipal council member/past council members, other
formal and informal leaders in the village:
Name Designation
1.
2.
3.
4.
5.
43. List the names of the non-governmental organization/formal and non-formal groups
in the village:
1.
2.
3.
4.
5.
6.
44. Tick the existing facilities in the village (or nearby) which have potential for vocational
training:
(a) Tailoring ( )
(b) Beedi rolling ( )
(c) Agarbathi (incense sticks) making ( )
(d)Making baskets/Mats ( )
184 Community Based Rehabilitation of Persons with Disabilities
(e) Sericulture ( )
(f) Dairy ( )
(g) Poultry ( )
(h) Fisheries ( )
(i) Pottery ( )
(j) Brick making ( )
(k) Making papads/condiments ( )
(l) Rope making ( )
(m)Construction work ( )
(n) Toy making ( )
(o) Handlooms ( )
(p) Power looms ( )
(q) Printing ( )
(r) Cow herding ( )
(s) Flower vending ( )
(t) Fruit vending/vegetable vending ( )
(u) Farming ( )
(v) Others (specify) ( )
If yes to any of the previous questions, please enter details in the following table:
Sl. Name of the Type of Age Sex Marital Status Father Mother Occupation Income Educational
No. Disabled person disability (If adult) Name name Status
47. If you know of persons with disability in the village, tick the activities that have taken
place/are taking place for their welfare.
The interviewer should explain the following items to the key informants in order
to elicit the appropriate information).
1. Identification of disabled persons ( )
2. Assessment of disabled persons ( )
3. Medical/surgical treatment ( )
4. Physiotherapy ( )
5. Speech therapy ( )
6. Vocational training ( )
7. Job placement ( )
8. Admission to normal or special schools ( )
9. Use of aids and appliances ( )
10. Others (specify) ( )
48. With respect to welfare of disabled persons, what does the community expect from the
organization?
186 Community Based Rehabilitation of Persons with Disabilities
49. What services can the community extend to support the organization in delivering services?
PROFORMA 3
Sl. No. Names of the persons Age Sex Relationship to Educational Occupation Income per Marital Remarks
in the household the head of the status month status
family
188 Community Based Rehabilitation of Persons with Disabilities
2.
3.
4.
190 Community Based Rehabilitation of Persons with Disabilities
If a disabled person is found in this house, please fill up Appendix to proforma 3. If there
are no disabled persons proceed to the next household.
One Appendix to proforma 3 is required for each disabled person. If more than one disable
person is found, use more Appendices to 3.
_______________________
_______________________
Signature of Interviewers
Source: Thomas Maya, Pruthvish S. “Identification and Needs Assessment of beneficiaries
in Community based rehabilitation initiatives” Monograph, ActionAid India, 1994.
Annexures 191
ANNEXURE TO PROFORMA 3
Measles
10. History of major millestones of development (if a child) The interviewer should check
with the care giver about the development achieved by the child on each of the following
items and enter the same in the column below
18. From the time that disability was identified, do you think it is increasing? Decreasing?
Remaining the same?
19. Does the disabled person have any other prolonged sickness? Yes/No
If yes, details __________________________
20. Does any other person in the family/relatives have similar or other
forms of disability Yes/No
If yes, give details __________________________
1. Assessment of disability
2. Medical/surgical treatment
3. Physiotherapy/speech therapy
4. Occupational therapy
5. Aids/appliances
6. Counseling
7. Normal school admission
8. Special school admission
9. Vocational training
10. Job placement/self employment
11. TRYSEM scheme
12. Physical handicap pension
13. Bus/train pass
14. Medical certificate
15. Scholarships
16. Others (specify)
194 Community Based Rehabilitation of Persons with Disabilities
[General details:
Illiterate, Primary School, High School, Diploma (specify). Degree (specify), Post-
Graduation (specify)
Technical details:
Certificate course. Diploma course, Degree course (specify)
Any trade, skill, craft Self-employment]
29. (a) Whether enrolled in regular educational institutions? Yes/No
(b) If no, explain why ________________________
(c) If yes, whether education is continuing to date? Yes/No
(d) If no, explain why________________________
(a) Father
(b) Mother
(c) Wife
(d) Children
(e) Neighbours
(f) Peers
(g) Employer
(h) Colleagues at work
(i) Others (specify)
36. Having made an initial review of the disabled person, what interventions do you feel
are required and how will you plan the same:
SI. Interventions Required A How and when will you
No. Not Required B plan the same
Have to confirm C
(white the appropriate letter in
the column below)
1. Assessment
2. Activities of daily living skills (ADLS)
3. Medical/surgical treatment
4. Physiotherapy
5. Speech therapy
6. Occupational therapy
7. Aids/appliances
8. Counseling
9. Admission to normal school
10. Admission to special school
11. Vocational training
12. Job placement
13. TRYSEM scheme
14. Physical/handicap pension
15. Bus/train pass
16. Medical certificate
17. Scholarships
18. Others (specify)
1st month 2nd month 3rd month 4th month 5th month
Translation of proformae
Printing/procurement of proformae
Consolidation of data
Report writing
196 Community Based Rehabilitation of Persons with Disabilities
Prevalence Data
Female Total Locomotor Communication Visual Mental Epilepsy Leprosy Mental Multiple Others Total
disabilities disabilities disabilities retardation illness disabilities
M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T
Annexures 197
BLANK FORMAT 2 FOR SURVEY DATA ANALYSIS
198
• • • • > 2 cows
• • • • > 6 goats/sheep
• • • • T.V. Sets
• • • • Radios
• • • • Two wheelers
• • • • Bullock Cart
• • • • Tractor
Community Based Rehabilitation of Persons with Disabilities
• • • • Car
• • • • Sofa set
MUSLIM
CHRISTIAN
SIKH
OTHERS
TOTAL
No. %
NATURE OF HOUSING
OWN HOUSE
RENTED HOUSE
TOTAL
* If is useful to compute this table disabilitywise for each vilage/slum and then a consolidated list
is to be prepared for the whole project area. DISTRIBUTION OF FAMILIES ACCORDING
** to be filled up (for adults only) if relevant TO HOUSING
Annexures
199
Contd...
BLANK FORMAT 6 FOR SURVEY
BLANK FORMAT 5 FOR SURVEY DATA ANALYSIS DATA ANALYSIS
1. Assessment
3. Medical/surgical treatment
4. Physiotherapy
5. Occupational therapy
6. Aids/apliances
7. Counselling
9. Vocational training
17. Scholarship
18. Loan
Leprosy in a majority of instances, can be identified only on the basis of a proper inspection.
a. A thorough inspection of the body surface (skin) to the extent permissible in good natural
light for the presence of tell tale evidence of leprosy.
b. Feeling the commonly involved peripheral nerve for the presence of thickening and/
or tenderness, e.g. inner part of elbow; behind the ear; outer part of the knee, outer
part of the ankle; etc.
c. Testing for loss of sensation of pain (using a skin needle) or light touch, (e.g. wisp of
cotton wool).
d. Deformities like paralysis of muscles of hand and feet; claw hand; loss of fingers or
toes; foot drop; claw toes and other deformities.
e. If there is a doubt in diagnosis, refer the person to the nearest health facility and follow-
up.
SOURCES
1. ICMR Centre for Advanced Research on Community Mental Health. “Features of Mental
Disorders’, Department of Psychiatry, National Institute of Mental Health and
Neurosciences (NIMHANS), Bangalore, India, 1988.
2. Larson H. (Ed). “Childhood Disability Information Kit”, UNICEF, Kathmandu, Nepal,
1983.
3. Minairc P. “The use of International Classification of Impairments, Disabilities and
Handicaps (ICIDH) in Rehabilitation”, Strasbourg, Council of Europe, Publications and
Documents Division, 1989.
4. Park J.E. and Park K. “Text Book of Preventive and Social Medicine”, Banarasidas Banot,
Calcutta, 1989.
5. Pruthvish S. and Thomas M. “Identification and Needs Assessment of Beneficiaries
in Community Based Rehabilitation Initiatives”, ActionAid Disability News, Vol 4. No.l,
1993.
6. National Institute for the Mentally Handicapped. “Mental Retardation - A Manual
for Village Rehabilitation Workers’, Secundrabad, India, 1988.
7. “Sarvekshna”, Journal of the National Sample Survey Organisation, Department of
Statistics, Ministry of Planning, New Delhi, Vol.VII, No. l-2, 1983.
8. Pahwa A. (Ed). Il Li dn on Community Based Rehabilitation”, District Rehabilitation
Centre Scheme, Ministry of Welfare, Govt. of India, New Delhi, 1990.
9. World Health Organisation. “Training in the Community for People with Disabilities”,
Geneva, 1989.
10. Dr. Maya Thomas and Dr. S. Pruthvish (1994) “Identification and Needs Assessment
of beneficiaries in Community-based rehabilitation initiatives” Monograph, ActionAid
India.
Annexures 203
ANNEXURE III
4. Speech disability
(5 years and above) 942 557 1499 298 169 467
5. Hearing and/or speech
disability (5 years and 2009 1490 3499 557 426 983
above)
6. Locomotor disability 4396 2411 6807 1370 762 2132
Estd. (000) total persons 326820 307537 634357 117121 104640 221761
based on 1991 Census
population
* At least one of (i) visual, (ii) hearing, (iii) speech and (iv) locomotor disability.
** The total estimated population is obtained by using 1991 census population projected
for 1st October, 1991.
206
Table AIII.6: Per 1000 distribution of households which reported at least one disabled person by number of
disabled persons in the household and average household size
size
person
person
persons persons
one disabled
P.C. of hrs
P.C. of hrs.
one disabled
Average hh.
which at least
Average hh.
1 2 3 or more 1 2 3 or more
. which atleast
Andhra Pradesh 914 81 5 4.9 9.98 922 69 8 5.3 7.67
Assam 951 47 2 5.6 5.61 972 25 3 6.0 4.86
Bihar 934 63 3 6.0 7.45 914 84 3 6.8 6.67
Gujarat 936 59 5 6.0 8.30 929 65 6 5.7 7.72
Haryana 900 97 4 6.7 9.73 925 71 4 5.5 5.78
Himachal Pradesh 892 105 3 6.3 13.62 917 79 4 4.8 3.98
Karnataka 923 70 7 6.1 10.06 929 67 4 6.1 6.38
Kerala 934 63 3 5.6 8.59 923 73 4 5.9 7.73
Madhya Pradesh 914 82 5 6.3 9.94 923 7 4 6.5 6.95
Maharashtra 901 95 4 5.6 9.64 919 75 6 5.4 6.81
Orissa 933 66 1 5.3 10.48 923 66 10 5.3 7.79
Punjab 882 113 4 6.3 13.95 913 82 5 5.6 7.63
Community Based Rehabilitation of Persons with Disabilities
Andhra Pradesh 224 154 617 1000 654 206 143 648 1000 194
Assam 212 191 591 1000 149 191 341 465 1000 19
Bihar 257 157 570 1000 785 253 188 544 1000 109
Gujarat 190 170 625 1000 785 166 186 646 1000 130
Haryana 213 210 573 1000 250 216 243 540 1000 36
Himachal Pradesh 260 174 557 1000 84 305 163 464 1000 3
Karnataka 214 200 582 1000 374 160 178 654 1000 121
Kerala 242 193 555 1000 237 208 192 594 1000 76
Madhya Pradesh 266 175 552 1000 607 223 191 583 1000 149
Maharashtra 173 138 683 1000 853 152 186 655 1000 297
Orissa 206 132 659 1000 337 137 289 566 1000 46
Punjab 172 163 652 1000 260 172 152 667 1000 66
Rajasthan 258 189 547 1000 384 216 149 627 1000 60
Tamil Nadu 145 185 663 1000 473 117 173 699 1000 204
Uttar Pradesh 286 161 546 1000 1356 274 169 553 1000 272
West Bengal 195 123 674 1000 534 147 163 687 1000 173
All-India 229 164 599 1000 7442 188 180 625 1000 2078
Annexures
Estd. (000) No. of Disabled
207
208 Community Based Rehabilitation of Persons with Disabilities
Medical/surgical
Cerebral Palsy
Other reasons
Other illness
intervention
Not known
Arthritis
Old age
Leprosy
diseases
Stroke
Burns
Polio
State
ANNEXURE IV
Main Causes
One child in ten is born with or acquires a physical, mental, sensory, intellectual or
psychological disability due to preventable disease, congenital causes, malnutrition,
micronutrient deficiencies, accidents and injuries, armed conflict and landmines:
500,000 children lose some or part of their vision due to vitamin A deficiency. Iodine
deficiency disease (IDD) is a leading cause of mental retardation and physical disability.
An estimated 28 million babies are born each year at risk of mental impairment due
to insufficient iodine in their mothers’ diets. At least 140,000 children become disabled by
poliomyelitis (polio).
For every child killed by armed conflict, three are injured and permanently disabled.
More than 6 million children have become disabled in the past two decades and only 10
to 20 percent of those in need of prosthetics and other supports had access to them.
Fourty percent of the 26,000 persons killed and injured by landmines every year are
children. Over 10 million children are psychologically traumatized by armed
conflicts.
Situation analysis and data collection: Accurate data on the magnitude, prevalence and types
of disabilities among children is essential for programme planning and implementation.
National census and surveys should include information on childhood disabilities.
Inclusive education and vocational training: Approximately 98 percent of children with disabilities
have no access to schools. Education, social integration and preparation for a productive
life of youth with disabilities need priority attention.
Public education and advocacy: Children and persons with disabilities are stigmatized and
negatively portrayed in many societies, even by the official media. Media campaigns should
emphasize the potential contribution of children with disabilities.
Legislation in conformity with the CRC: Some countries need assistance developing legislation
in conformity with the CRC and the UN standard rules on equalization of opportunities
for persons with disabilities.
Early intervention, including early detection and identification during the first four
years of life, is particularly critical for infants with disabilities and their families. Failure
to provide intervention and support to parents and caregivers, results in secondary disabling
conditions which further limit the child’s capacity to benefit from educational opportunities.
This is an area where multisectoral collaboration is essential, involving health, education,
social welfare and community development.
Source: www.unicef.org
Annexures 211
ANNEXURE V
Recognising the fact that the pace of implementation of “The Persons with Disabilities Act,
1995” has been dismally slow and keeping in mind the urgent need to fulfil the promises
made under the Act, we, the representatives of the civil society met in New Delhi on 5
and 6 October 1998, and having conducted a detailed review of the progress in the
implementation of the Act, do hereby call on the following to immediately undertake the
steps outlined hereunder to secure the welfare, empowerment and rights of the disabled
persons.
• Governments should widely consult organisations of PWDs and hold public hearings
while preparing amendments to the existing Act and in formulating policies for the
disabled.
• Governments should not misinterpret the clauses and deny opportunities to students
learning what they want. In fact, disabled students should be given opportunities to
participate in all regular and co-curricular activities like their non-disabled counterparts.
• Governments should encourage and promote quality needs-based research in the areas
of human power development, delineating prevalence and incidence of disabilities,
appropriate technology, material development linking universities and NGOs.
• The concerned authorities must promote a non-handicapping environment by providing
guidelines on barrier-free buildings, signage, modification to public transport, designated
parking spaces in all public places, etc.
NGOs
• Closely watch, monitor and influence the governments to implement the Act and achieve
set targets.
• Support the governments to undertake orientation programmes for government personnel,
employers, the general public, etc.
• Motivate, educate and sensitise the Government, panchayat members, the general public
and employers to take a proactive role towards all areas of welfare, empowerment and
rights of disabled people.
• Provide resource base and support to Governments for implementing the Act.
• Prepare a training package converting the Act into awareness-raising material and train
parents of the disabled and PWDs through training programmes.
• Design, develop and conduct leadership training programmes for persons with disability,
parents and NGO members, especially groups of disabled persons, to take up professional
advocacy work in respect of the Act.
International Agencies
• Support NGOs, government and disabled persons’ organisations in the implementation
of the Act.
• Support policy development, information exchange, material development, training and
networking among NGOs, Disabled Persons’ Organisations, academic and research
institutions, Government, etc.
Corporate Sector
• Ensure a barrier-free environment in places of work. Also ensure safety and equal
opportunities to PWDs.
• Employ at least 5 percent of the work force at all levels from among persons with disability.
• Support the Government to establish and maintain support systems for the care of the
severely disabled, one in each district.
• Apex bodies like CII, ASSOCHAM, FICCI should educate and motivate employers
regarding the provisions of the Act to secure effective implementation.
Annexures 213
Support Institutions
(Research Institutes, Academic Institutions, Universities, Specialist Hospitals, National
Institutes, Rehabilitation Institutions run by NGOs and Governments)
• Undertake research into needed curricular changes, appropriate technology for service
delivery and aids and appliances towards implementation of the Act.
• Undertake research into various facets of Community-Based Rehabilitation (CBR).
Media
• To regularly inform the public of news and activities pertinent to people with disabilities
as well as publicise issue-based stories.
• To act as a watchdog and ensure that the disabilities Act is implemented in letter and
spirit.
Public
• Support and encourage families with PWDs, particularly those based in rural areas, to
ensure education, skill training, social integration and employment of persons with
disability.
• Ensure that roads, buildings, religious places, shops, schools, marriage halls, etc. are
accessible to PWDs.
• Co-operate with the Government, NGOs and disabled persons’ organisations to develop
Community-Based Rehabilitation programmes and a barrier free environment for persons
with disability.
• Perform local fund-raising, and join hands with the government and NGOs to take
responsibility for disability programmes.
‘A Call for Action’ was arrived at during the National Advocacy Workshop held at United
Services institution at New Delhi (5 and 6 October 1998). The endeavour was organised
by National Centre for the Promotion of Employment for Disabled People (NCPEDP), New
Delhi, Concerned Action Now (CAN), Council for Advancement of People’s Action and
Rural Technology (CAPART) and ActionAid India.
1-14 Years 2-14 years 3-14 years 1-14 years 10-14 years
State / U.T
Head Rolling Sitting Walking Talking Slow/lagging Performing Comprehending Development of Money
control behind in daily instructions speech and handling
development routine language
Andhra Pradesh 14 24 17 43 44 25 53 48 36 47
Arunachal Pradesh 412 378 413 435 406 54 195 226 118 82
Assam 171 161 129 146 153 71 163 216 125 131
Bihar 155 187 100 111 94 36 63 96 101 126
Goa 128 270 90 5 - 5 23 90 63 5
Gujarat 116 141 45 62 87 15 23 26 84 45
Haryana 33 122 9 16 6 31 45 40 75 44
Himachal Pradesh 139 116 34 30 18 22 42 103 109 100
Jammu & Kashmir 45 121 19 33 13 40 46 60 95 120
Karnataka 24 40 25 40 23 14 10 20 54 57
Kerala 21 22 11 10 9 15 21 11 38 56
Madhya Pradesh 154 175 101 92 70 36 76 81 97 107
Maharashtra 48 61 33 34 26 31 25 24 48 50
Manipur 24 146 24 22 59 16 18 32 44 68
Meghalaya 45 113 106 28 20 19 36 52 47 45
Mizoram 155 22 0 7 4 9 60 63 18 15
Nagaland 648 677 536 634 186 92 166 166 209 107
Orissa 28 47 33 32 29 47 60 65 53 118
Punjab 13 68 28 45 37 49 51 51 61 87
214 Community Based Rehabilitation of Persons with Disabilities
Rajasthan 63 97 35 61 29 32 77 90 81 124
Sikkim 71 84 81 105 31 55 97 145 61 14
Tamil Nadu 57 52 39 49 43 38 30 38 34 41
Tripura 251 275 199 218 158 64 50 122 68 151
Uttar Pradesh 156 169 93 90 62 22 50 52 77 140
West Bengal 78 102 60 49 34 44 78 106 78 102
A & N Island 38 21 25 14 10 13 5 17 12 49
Chandigarh 0 2 1 15 4 1 4 3 25 6
Dadra & Nagar Haveli 26 17 1 11 9 4 2 1 5 237
Daman & Diu - 2 - 3 2 2 5 4 52 2
Delhi - - - 1 1 2 - - 21 71
Lakshadweep 4 4 22 23 10 21 25 23 28 6
Pondicherry 241 243 233 7 23 25 24 33 24 64
All-India 93 115 61 66 52 31 54 64 72 93
Table AVI..2: Number of children with delay in attaining specified
developmental milestones per 1000 children for each state/U.T.
1-14 Years 2-14 years 3-14 years 1-14 years 10-14 years
State / U.T.
Head Rolling Sitting Walking Talking Slow/lagging Performing Comprehending Development of Money
control behind in daily instructions speech and handling
development routine language
Andhra Pradesh 21 43 26 29 38 20 36 24 26 24
Arunachal Pradesh 253 319 146 54 125 132 206 108 107 67
Assam 155 168 206 202 194 60 153 198 121 181
Bihar 137 168 141 109 106 29 65 88 90 88
Goa 24 137 1 1 1 3 1 31 2 2
Gujarat 43 75 16 39 43 25 36 36 65 34
Haryana 31 54 19 15 45 33 46 43 45 31
Himachal Pradesh 234 185 43 66 67 16 42 82 76 28
Jammu & Kashmir 50 115 59 57 52 31 20 20 36 49
Karnataka 3 46 7 24 17 17 28 48 53 41
Kerala 20 30 17 19 18 32 15 15 35 19
Madhya Pradesh 99 132 71 77 69 18 51 49 76 44
Maharashtra 36 55 16 25 10 35 25 20 42 28
Manipur 11 39 19 19 19 3 6 5 7 51
Meghalaya 30 306 136 43 17 26 17 31 17 54
Mizoram 0 13 1 10 1 2 2 2 9 76
Nagaland 635 643 532 532 134 83 151 165 193 217
Orissa 12 8 29 21 26 21 62 76 108 76
Punjab 18 89 15 27 67 18 39 37 46 60
Rajasthan 109 140 62 87 36 25 63 59 62 25
Sikkim 182 97 147 145 21 28 150 171 79 15
Tamil Nadu 16 27 11 14 12 20 21 34 19 30
Tripura 222 218 221 224 110 18 16 57 36 361
Uttar Pradesh 140 156 73 92 46 34 38 37 50 56
West Bengal 47 60 45 35 17 39 77 73 62 65
A & N Island 33 69 57 28 25 6 16 35 76 2
Chandigarh 42 84 3 2 4 5 7 6 6 3
Dadra & Nagar Haveli - 3 24 8 - 9 7 3 108 167
Daman & Diu - - 7 3 1 4 9 28 37 33
Delhi 133 131 34 21 16 47 46 50 63 58
Lakshadweep 19 19 20 7 29 28 5 8 23 56
Pondicherry 127 155 150 7 19 12 26 9 71 325
All-India 68 90 44 48 36 29 41 44 52 46
Annexures
215
216 Community Based Rehabilitation of Persons with Disabilities
Table AVI.3: Per 1000 distribution of children of age 0-14 years by type of blood relationship
between parents for each state/UT
ANNEXURE VII
PRACTICAL EXERCISE
Practical Record for students; content of practical; developing a field practice area; suggested
exercises for students.
Field Visits
It is useful to consider field visits to:
• Special Schools for Visually Disabled
• Special School for Children with Hearing Impairment
• Special School for Children with Mental Retardation
• Special School for Children with Cerebral Palsy
• Normal School where Special Children are integrated
* Similarly, faculty of physiotherapy are to identify and make a list of resource bases for CBR in the
neighbourhood of this institution.
** List from Karnataka only. Faculty are suggested to identify reasonable persons/institutions in their
neighbourhood
Annexures 219