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close this bookSustainable Development and Persons with Disabilities: The Process of Self-Empowerment (ADF, 1995, 117 p.)
close this folderSection I: Understanding and perception
View the document(introduction...)
Open this folder and view contentsChapter 1: Introduction
View the documentChapter 2: An integrated approach to sustainable development for persons with disability
Open this folder and view contentsChapter 3: The enabling environment: SAPs, development and disability
Open this folder and view contentsChapter 4: Community-based rehabilitation


Fred Musulo, Kampala Disabled Business Peoples Association, Uganda. (Photo by Marla Feldman)

Objectives of this guide

We live at a time when issues of major concern to large numbers of people on the earth's surface get on the global agenda for action. The electronic media have facilitated this process of globalisation. For the disabled people to put their cause on the world's conscience they have to compete (or join forces) with other causes - such as those of women, the environment, human rights, and global poverty.

Getting disability on the global agenda is not the objective of this guide. The International Year of Disabled Persons (1981), the United Nations Decade of Disabled Persons (1983-1992), and the World Programme of Action for the Disabled Persons were designed for putting on the ground those broader objectives. Of course, more can be done in this regard. And in some ways, this guide might indirectly help.

Ours, primarily, is but a modest, and practical objective. We want to look at the terrain on which disabled people live and struggle. We would like to discuss, for example, if the best strategy for people with disabilities is to demand special treatment for themselves on account of their disability, or to join the mainstream of economic life and compete with the able bodied people. These are the kinds of issues we would like to examine. What does the economic landscape look like when the PWDs start Income Generating Projects (IGPs)? How do they go about planning their projects? What are the resources which they can draw upon... and the challenges? How do they lobby for change? What are the advantages of networking? And so on.

This guide is even more modest than its title would suggest. A "guide," after all, is only a guide; it is not an answer to problems. It is rather like a route map of a complex, spontaneously grown township whose streets and corners are really known only to the people who live there. It shows the general direction of the journey ahead. It does not say what you will find at the end of your journey.

Thomas Mouandza, a member of Young Deaf Handcrafted Furniture Makers in the Congo making a point in sign language. (Photo by Marla Feldman)

There is no substitute for concrete action based on a concrete situation.

Therefore, this "Guide" should not be confused with a technical manual on IGPs. There are many of these around. Rather, it is an exploration of the principles which should guide action. For example, we suggest in this guide that "as a matter of principle," it is better to exhaust all local resources before turning to donor funding; that, as a matter of principle, projects that empower the disabled people are preferred to welfare oriented projects. The Guide goes on to discuss ways in which the PWDs can empower themselves in the various environments in which they live.

There may be more than one path to the destination. Circumstances differ.

Personalities matter. Everybody cannot follow the same path. When ducks are cold, they enter the water. When chickens are cold, they roost in the trees. It is the same with people. Some are rich, some poor. Some are disabled in one way, others in another way. No useful strategy is eternal, its path carved out in stone. We innovate as we go along. It is in this spirit of adventure that we embark on this exciting journey.

But, to be honest, the objective of the guide is not all that modest. One of its objectives is to try to influence events and the general direction in which policies that affect the lives of people with disabilities are going. It's not all sewn up; PWDs have space to influence decisions - within Governments, NGOs, international organisations and donor agencies.

These, then, are the objectives of this guide.

Who may use the guide

There are several categories of possible readership. As indicated earlier, this book is not strictly a "manual," and yet, there is information, especially on matters related to building economic self-reliance (Section II of the book), that can be useful to the Persons With Disabilities engaged in income generating projects. Wherever relevant, each chapter, therefore, ends with 'Action Guidelines" for Persons with Disability.

However, the book is aimed at a broader audience. The main argument of the book supports a strategy of self-empowerment of the PWDs. But the PWDs cannot advance this strategy without allies and a support base in the families and communities in which they live. Hence, community leaders may also find the book a useful source of information and principles by which to guide their action.

A third category of readership includes the professionals engaged in disability rehabilitation work. The contribution of professionals is recognised, but in general, the guide takes a critical view on isolating professional work from the overall social context, and advocates an approach to their work that is empowering of the PWDs rather than one that disempowers them.

A fourth category of readership may be found within those departments of Government that deal With PWDs. They may be spread among different Ministries of Government, both at the Central and Local levels. Hence, where relevant, the chapters end with "Action Guidelines" which they might find useful. A fifth category of readers are the Non-Governmental Organisations (NGOs) engaged in their various functional interaction with PWDs.

The sixth category of readers who might find the guide useful are organisations within the UN system (such as the ILO, WHO, UNICEF and UNDP) and inter-governmental organisations such as the OAU. And the seventh category of readers who would find some sections of the guide useful (e.g. those dealing with advocacy and networking) are the international NGOs representing or relating with PWDs, such as the Disabled Peoples' International, Rehabilitation International, the World Blind Union and the World Federation of the Deaf

With such a broad audience, obviously not everything in the book is of relevance to everybody. In other words, the book can be read in parts. However, for a certain kind of readership it may be useful to read through the entire document because there is a certain sequential logic that connects chapter one through chapter ten. There is an argument built as the chapters unfold. Indeed, readers must be warned that they might find certain positions in the book controversial, even argumentative. This is deliberate. It is to foster debate. There is no human progress without debate. Past knowledge must be challenged by new ideas, new ways of looking at reality, new visions.

This, and the fact that the guide tries to provide for a broad readership, has inevitably affected the language and "tone" of the book. Clearly, the document could not linguistically be reduced to a "minimum common denominator" to the level of the most marginalised among the PWDs. The Entebbe Workshop participants came from varied backgrounds, but as Nelson Isiko was to point out, the very poor were not there. The language of discourse was, at times, conceptually very high. This guide has tried to simplify some of these concepts, but it has retained the conceptual richness of the discussion. Concepts are important tools for debate, and the PWDs would find some of the language used in the book a useful means of dialogue when discussing matters of concern to them with those who make and administer government and inter-governmental policies.

Language and liberation

Whilst we are on the question of language, there is one more small, but important, matter that we must clear before we proceed to the text. No social group (with the possible exception of women in contemporary times) is as sensitive as the people with disabilities on the question of how they are addressed.

And rightly so. The disabled people as a group have been subjected to much social abuse. People often refer to them not by their name but by their disabilities.

Please call me by my name, not by my disability.

There is also a tendency to view them as "abnormal" and therefore not qualified to carry out a "normal" life of living and loving. In many local languages, there are many labelling words referring to people with disabilities. And yet, as the following poem by Tony Wong of Jamaica shows, it is often the "able"-bodied who have more serious disabilities than those who are physically or intellectually impaired. The attitude of the able-bodied disables both the abled and the disabled.

Who is Disabled?

If you fail to see
The person
But only the disability,
Who is blind?

If you cannot hear
Your brother's
Cry for justice
Then who is deaf?

If you do not communicate
With your sister
But separate her from you,
Who is disabled, her or you?

If your heart and your mind
Do not reach out to
Your neighbour,
Then who has
The mental handicap?

If you do not stand up
For the rights of all persons
Then who is the cripple?

Your attitude towards
Persons with disabilities
May be our biggest handicap,
And yours too.

So the struggle to remove the
prejudice of language is itself a
struggle for liberation.

On the other hand, however, in some cases this exercise has now swung to the other extreme. People, especially the able bodied, seek to find words that salve their conscience rather than change their prejudice. Words such as "mentally challenged" are invented as if words would change reality. The question may be asked: Who coined this terminology - the abled-bodied person or the "mentally impaired"? It is worse when words become a substitute for changing that reality. Language becomes a smokescreen to hide deeper prejudices. Calling a "black man" a "person of colour" does not remove the deeper prejudice, just as calling a drunk a "person of different sobriety" does not change the reality, nor calling a blind person one who is "optically inconvenienced." Some of the worst offenders are those in the medical profession who refer to the physically disabled persons as "orthopaedically impaired".

We must fight against linguistic insults, to be sure. But let us not hide behind linguistic relief either. To bring real relief we have to change the material and social reality of the disabled people. We have to change the behaviour of both the PWDs and the able bodied people by developing a positive attitude towards one another. This is the essence of mainstream integration.

Venkatesh: "I prefer to be called 'blind', rather than a 'visually impaired person'. 'Visually impaired person' is such a mouthful. Whether you call me blind or visually impaired is not important. The most important thing is what I feel about myself. It's about self-esteem."

Coleridge: "So does that mean that blindness is part of your identity which you feel quite happy with?"

Venkatesh: "If I am what I am today, you know, deep inside, the way my mind works, it is because of my disability. Disability has enriched my life as a person."

Amadou Issaka, Rehabilitation Project for the Blind in Niger, taking notes on his Brailler. (Photo by Marla Feldman)

Debate and discussion must continue

Finally, debate and discussion must continue. There are no final and absolute truths. Indeed, that is where the professionals have sometimes made serious mistakes. All rigidities must banish in the fresh light of discussion. It is in this spirit that each chapter ends with a few questions arising from the text. These, and other questions, must continue to agitate the minds of both the practitioners and the PWDs themselves.

Chapter 2: An integrated approach to sustainable development for persons with disability

Why an Integrated Approach?

In the introduction, we talked about social prejudices against disability. When these prejudices find their way into policies and practices of government, they get institutionalised. In other words, the prejudices appear in a new, more formidable form. They get cast in bricks and mortar. A building is erected with the letters: "Rehabilitation Centre" for the blind, or for the deaf, or for the physically or mentally disabled people.

This institutionalised prejudice, at a still higher level, could take the form of a whole government ministry, or a department within a ministry, set aside to look after the disabled people. With the poor, the aged, the unemployed and other marginalised strata of society, the disabled people become objects of "social welfare".

What we are advocating here is an integrated approach to disability. In this chapter, we deal with "Integration" at the conceptual and policy level; in another we deal with another expression of it, i.e. at the community, or grassroots, level.

What does an Integrated Approach Imply?

It implies, first of all, that disabled persons must not be treated as objects of social welfare. To be sure, there are those amongst them, just as there are those amongst the able bodied, who may need support from the state. Among these belong, the aged, the poor and the unemployed. There are amongst the disabled people those whose disability may be so severe (such as those with multiple disabilities) who would deserve state assistance. But this does not) justify placing the whole category of people called "the disabled" under welfare.

Secondly, it implies that insofar as disability is a social issue, it should be the responsibility of the government cutting across particular ministries. Disability is not the project just of the Ministry of Social Welfare; that is the road to isolation. The integrated approach makes it the responsibility of all ministries, just as it is the responsibility of all ministries to be responsible for the environment, the rights of women and those of the "abled" people.

Thirdly, integration means creating harmony, an attitude of caring, within the families and the communities irrespective of whether their individual members have disability or are able bodied. The disabled person must be able to live and love like any other member of the family or the community.

And finally, integration means creating a space and an opportunity for the people with disabilities to merge within the mainstream activities and the general system of the society.

Of course, given the legacy of past policies and prejudices, integration cannot be achieved overnight. Even with the best will in the world to change things around, institutions stay in a state of transition for a long time. But integration must be the objective of all those who are concerned with the genuine welfare of people with disabilities.

What, Then, are the Barriers to Integration?

A barrier is like a fence or a hurdle. You have to jump it or go around it in order to reach out to the other person. At the best of times, it slows down communication; at worst it stops communication altogether. When communication stops or is obstructed, the result is isolation. That isolation reinforces the very prejudices which may have been the initial cause for creating that barrier. If, furthermore, those isolated from the "mainstream" of social and economic life are disabled for various reasons, this reinforces their marginalisation and disempowerment. It is a vicious circle. The prejudice breeds isolation; isolation further feeds into reinforcing the prejudice. Cutting off from the mainstream of social and economic life marginalises those who are so cut off, and marginalisation takes them further and further away from the mainstream. This, in the days of apartheid South Africa, used to be called "separate and unequal development", and, as we know, this cannot be a lasting solution to any social problem.

What, then, are these barriers to integration that we must pull down? The following is a schematic presentation of these barriers in the form of a "continuum" [a "continuum" is an unbroken, or fluid, series of affairs that, in this particular case, feed into one another; the series are connected, not separate or isolated].

Nelson Isiko at the Entebbe Workshop: "I had 1, 000 friends, and was left with only 7 when I lost my sight."

Barriers to Integration

Lack of self-esteem

Negative social attitude

Lack of opportunities to: e.g. employment education

Lack of access to resources

Infra- structural and architectural barriers

Legal and government policy & practice

The continuum is from the personal, the subjective, to the highest institution of the state, namely the government. Lack of self-esteem is often the product of the environment, including the manner in which the disabled persons are brought up by the rest of the society. It remains the biggest barrier to PWDs' advancement. Once that is restored (and this should be the only legitimate use of the word "rehabilitate"), then half the battle is won. The rest is a matter of mainstreaming integration.

What room is there for the institutional approach in this?

Historically, the presence of human beings with disabilities has generated a slowly evolving response. It has moved from trying to eliminate them, to the "poorhouse" approach (that is, removing them from the view of the non-disabled people), to institutional care.1 In more recent years, however, governments are closing down institutions because of budgetary difficulties. That now is going to the other extreme.

Members of the Greenfields project. (Photo by Marla Feldman)

Institutions are necessary, but they are necessary not as homes but as back-up support to community and family efforts. And the approach within the institutions must be applied not in a wholesale manner to all the people with disabilities without regard to the specificity and gravity of each person. Flexibility of approach that respects the dignity of the human being must at all time be the cardinal principle of institutional intervention.

Types of Disabilities

Physically impaired

Mentally impaired

Hearing impaired

Visually impaired

Speech impaired

Other impairments

Integration of Cross-Disabilities

There is another sense of integration that must be discussed, namely the integration of people with different disabilities in common activities. Institutional isolationist policies not only separate the PWDs from the able bodied, but also the PWDs from one another based on their particular disabilities. This is a further extension of the same policy of "social apartheid."

These, like all categories, are "broad" categories, and hide real differences that may exist within each category. For, of course, some are more severely impaired than others within the same category, and these differences in degree are as important to take into account in any programme as differences in the type of disability. Once again, there is some justification for "transitory" isolation of some forms of disabilities, or some training courses (e.g., to learn braille). But this does not justify isolation as a matter of policy.

Sustainable Development

Now we come to the second phrase in the title of this chapter, "sustainable development". "Development" has a positive echo, it evokes good feeling. Everybody wants to "develop"; you cannot argue against it. And indeed why should you? Is it not the right of every individual to want to better himself or herself materially? Is this not what human existence is all about? That is correct.

Because "development," as it has taken place over the last hundred years or so has not been, and is not, "sustainable." Development cannot go on in the manner it has all these years. What is taking place is backwards development, perverse development, a disagreeable kind of development. In fact, if the word is to mean something positive, something we can all support, then it is not "development" at all.

According to a 1992 report by the International Food and Agricultural Development (IFAD), called "Report on the State of World Rural Poverty," the poor in the world have increased in number. Today, one person in every five is "poor" in the sense that he or she does not have the means for even basic subsistence. This is unprecedented in world history. In ages before the "modern" epoch of industrialisation, people were indeed materially "backward" when compared to the technological "advances" of our present times, but, within the means available to them and barring natural catastrophe, people in general had enough to "subsist." Today even this basic subsistence is eluding over a billion of the world's five billion people. Poverty thus has become the biggest issue on the world's agenda.

Next to poverty is Environment. Here, too, "development" has brought catastrophe to our environment. Never before in history was the very survival of the planetary ecosystem at stake. Today, humankind is destroying the very basis of its own existence. If industrialisation continues apace in the way it has done over the last 100 years, then within the next 100 years (or less) we would be destroying the bulk of the world's forests, entire river systems of large parts of the globe, the ecosystems that regulate the cycle of regeneration of our natural resources, the fertility of the soil from which we derive our foods, the purity of the air we breathe, the ozone layer that acts as a protective shield against the sun's rays, and we would have exhausted most of our non-renew able energy resources such as oil and natural gas, and most of the minerals in the bowels of the earth.

Why, then, we might ask, is there actually a global movement AGAINST development?

It is in this context that the concept of "Sustainable Development" entered the calendar of global conferences. During 1987, some of the leading citizens of our globe had decided that our present generation is engaged in so much environmentally destructive consumption that the survival of future generations is under serious threat unless "the needs of the present (are met) without compromising the ability of the future generations to meet their own needs."2

The delivery concept of "development"

But "development" has come to mean providing impoverished communities with relief assistance, money for "income generating projects," and material inputs to enable them to engage in production and marketing of commodities for their survival. The "delivery" deal of development dominates the work of most NGDOs in Africa. Development, in this instance, is defined as an outcome of delivering to the "needy" masses certain cc things" - whether these are actual material things (such as school books and blair toilets), or ideas (in the form of "expert" advice, or technical assistance).

How do we react to this? For sure, the practical aspects of "delivering" goods to people impoverished by the depressing condition of their economies is important. This kind of help should by no means be devalued or trivialised. But an exclusive preoccupation with these "bread and butter" issues could lead to serious problems of which we should be aware.

Concentration on providing cc goods and services" gives us the illusion that we are doing something to alleviate the poverty and marginalisation of our people, whereas, in fact, we are doing all the running in order to stay exactly where we are. Indeed we may be moving back wards. Why?

· Because we are not tackling the larger forces that create poverty, unemployment and alienation among our people.

· Secondly, we would be avoiding our responsibility to think through the workings of the larger system and leave all the thinking to be done by experts.

· Thirdly, the delivery concept disempowers people. It makes people believe that their development is a product of receiving donor funding from the North, and technical advice from their own or foreign consultants.

At the opening of the Entebbe Workshop, Hon. Eliphaz Mazima, Member of Uganda's Constitution Assembly representing PWDs, quoted the former President of Tanzania, Mwalimu Nyerere's definition of the term "development." Mazima highlighted the following seven points about the definition:

· Development is a process;

· It is the realisation of potential for self support and contribution to society;

· It involves the building of sell: confidence;

· It aims at leading lives of dignity which includes gainful employment that helps individuals to meet basic needs, security, equity and participation. These lead to fulfillment;

· Freedom from fear of want and exploitation; and

· Freedom from political economic and social exploitation; and

· Development starts from within.

Development is a product of "struggle" by the people, not "delivery" from the top

These seven points form the "ideological" glue that binds this Guide. They need to be revisited from time to time. Unless development starts "from within" nobody else is going to be bothered to do it for you.

A hen can sit on a stone and not produce a chicken. What hatches into a chicken is the force of life inside the egg itself. The force of change is inside oneself; outsiders can only provide "enabling conditions." No more.

[This is an adaptation from a quote by China's Mao Tse-tung]

Entebbe Workshop participants visiting the Greenfields Project, Mbale, Uganda. (Photo by Marla Feldman)


The "Internal" and the "External"

We ended the last chapter by talking about the centrality of the inner self, as opposed to an outside provider, as the primary basis for change. You are first and foremost your own redeemer.

First and foremost, for sure. But that implies that there are other, secondary, factors that can help too. Sometimes with the best will in the world, the environment is too harsh for the inner potential to realize itself. The egg. to get back to the old example, will not hatch if it does not get the warmth of mother hen. So whilst the "internal" force is the primary cause of change, the "external" environment, though secondary, is also important. That is the relevance of the "enabling environment," and what this chapter is about.

Barriers to "Enabling Environment"

In the previous chapter we talked about the "barriers" to integration. We identified the following barriers.

· Lack of self-esteem on the part of the disabled people themselves.
· Negative social attitude.
· Lack of opportunities, e.g. to jobs, education.
· Lack of access to resources, e.g. finance, equipment.
· Infrastructural and architectural barriers.
· Legal barriers and government policy and practice.

Thus, when we talk about the enabling environment we refer to the conditions, or circumstances, that must be created to enable PWDs to overcome these barriers. The question is: WHO should create this enabling environment? Who should act as mother hen? Who should provide the right warmth and moisture for the inner self to realise its potential?

Principal Stakeholders

The PWDs themselves

Families and Communities in which PWDs live


Donor Agencies


Who should create the enabling environment?

We call them "stakeholders" - people or agencies who have a stake, or interest, in the matter. We identified some of these in chapter two. Once again we put them in a continuum with the two key stakeholders - namely, the PWDs themselves and the Government - at the two extremes of the continuum.

The PWDs themselves are the principal stakeholders. If they do not struggle for their own rights, nobody else will create the enabling environment for them. In other chapters we shall talk about roles that can be played by the communities in which PWDs live, the NGOs and the donor agencies. Here we shall focus on the government, for if we asked ordinary people the question: "Who is principally responsible for creating an enabling environment for development?" the most likely answer would be: "The government. We voted them into power, and now it is up to them to provide us with the resources for development."

The Role of Government

Is the above assessment by ordinary people on the role of government right or wrong? Right, because the government is the highest expression of our collective will. We expect it to perform, to do something about "development." Wrong, because the governments in our third world countries are themselves hostages to more powerful forces outside of our nation-states. These forces (symbolically represented these days by the World Bank and the IMF, although that is a simplified version of a more complex truth) more or less dictate to our governments what they should do. We in Africa have won our "political independence", but not yet "economic independence." The first black head of state of independent Africa, Kwame Nkrumah of Ghana, used to talk about "neo-colonialism." He was right. He still is.

How much can be expected from governments?

Frankly, do not expect too much from our governments. They make promises to people in the heat of a political race for votes, but they can only partially fulfil these promises. Many of them are in budgetary crisis, and are busy borrowing from the domestic and international money markets and from "donors." Of course, corruption diverts some of these resources to private pockets. But even without it, there just would not be enough to meet the demands of everybody for education, health, housing, jobs, and a decent standard of living. In fact, there are more poor today than 10 or 20 years ago.

Above all, most African governments today are implementing World Bank designed Structural Adjustment Programmes (SAPs) which, among other things, have forced governments to reduce on social expenditure, such as education and health. Other effects of SAN are increased retrenchment of employees from both the private and public sectors, de valuation of the currency, and liberalisation of the market. All these measures are based on the assumption that African economics will become lean and competitive in the world market. That remains to be seen. In the short run, however, all evidence indicates that the SAPs have increased the marginalisation and impoverishment of large numbers of people in Africa. [At the end of this chapter, we give the example of Zambia's experience with a Structural Adjustment Programme.]

Why are we painting such a bleak picture? Because of three reasons:

One is to bring a sense of realism in what to expect from our governments.

Second, to remind ourselves that we must as far as possible stand on our own feet, mobilising whatever resources we have from our own means.

And thirdly, to encourage looking at things beyond our own selves. We have to join with all those forces that are looking for alternative development models to the one under which the bulk of humanity is getting impoverished daily.

Having said this, we cannot let governments off the hook. We must continue pressing our just demands. And what are these? These are, to put them rather schematically:

· Right to information,

· Equal rights to social welfare: e.g. jobs, education and health care;

· Right to participate in policy making;

· Equal access to resources for development: such as land, raw materials, skills, and appropriate tools and equipment;

· Accessible buildings and public facilities.

The government can facilitate an enabling environment by equalizing opportunities to the PWDs in respect of the above. There is the question of whether the PWDs deserve a "better than equal" opportunities on account of their disabilities. This is the issue of what is known as "affirmative action," but to this we shall return in a moment. Let us first elaborate on each of the above demands.

Right to information

This is vital. Without information it is difficult to realise all the other rights, such as the right to participate in national affairs in general with the rest of the community.

The PWDs need ready access to the various channels of information - both public (such as the radio, the television, newspapers, access to parliament, etc.) and private (such as company reports). This information should be in the language the PWDs can understand, including braille and the sign language.

Right to social welfare: e.g. jobs, education and health care

As indicated above, governments have been forced on account of SAPs to cut down on social services. Those at the bottom of the social pile are the ones who usually suffer from these cuts more than those at the higher levels of social hierarchy. This is a question of government prioritisation; to some extent it is also a question of how communities and families prioritise their needs and concerns. During hard times, for example, parents tend to favour boys to girls for education, and the able-bodied children to the ones who are disabled.

Governments and NGDOs, with the help of communities and the organizations of the disabled people, should investigate how SAPs are hurting the more vulnerable sections of our population. They should then take remedial action to ensure that the PWDs (and other similarly disadvantaged groups) are not made to shoulder the brunt of government cuts in social welfare programmes.

Give me information and I am no longer blind. - Nelson Isiko at Entebbe Workshop

The organisations of the disabled people need information on how governments are administering the social funds, where these have been set up, to cushion the impact of SAPs.

The general international experience, however, highlights the difficulty of separating the effects of SAPs from those of other factors, such as drought, poverty, etc. The experience in sub-Saharan African countries (PAMSCAD in Ghana, PAPSCA in Uganda, SDA in Malawi and Tanzania and the PRODEC in Cameroon) has shown that it is not enough to cushion the effects of SAPs. Governments have to do more than that; they have to have broad ranging policies that tackle the effects of general poverty and such occurrences as drought, as well as the effects of SAP.

Right to participate in policy making

It is not enough for the government to say they are implementing SAPs and therefore they have to cut down on social welfare, and that we must wait until the economy improves five or ten years down the line. People cannot wait that long, and who knows whether they will ever reach the "promised land"? They have immediate needs. If the government cannot meet these, they must explain why. They must give information on the terms under which they negotiate loans from the IMF and the World Bank. Maybe governments are wrong in pinning too much hope on SAPs. They have not succeeded anywhere in the African continent. So people everywhere want to take part in the debates on where their national economies are going, and whether Governments have the correct strategy in place. To enable this to happen, people need:

· access to information;
· knowledge on how government decisions are made;
· access to channels where critical decisions are taken;
· and capacity and opportunity to influence these decisions.

A.K. Dube leaving the hotel via a portable ramp build especially for the workshop (Photo by Marla Feldman)

Right to equal access to resources for development

It is not enough for governments to say, for example, that they have given a school for the blind, and therefore they have done their part. That's good but not good enough, because a school cannot be isolated from other developmental resources. If PWDs are to develop economic self-reliance, they need:

· access to resources (such as land and raw materials);
· access to training (whereby we can acquire skills);
· access to capital to start small enterprises;
· appropriate tools and equipment;
· and so on.

Right to accessible buildings and public facilities

Above all, PWDs need to be able to move around and integrate with the community. The public transport systems in most countries are atrocious as far as the mobility of PWDs is concerned. So is access to public buildings such as the Post Office, banks, museums, libraries, and provincial and district headquarters. It is the responsibility of governments to ensure that these public places are accessible to PWDs, especially those who are physically impaired.

Women and Children with Disabilities (WWDs and CWDs)

Grace at the Entebbe Workshop (speaking in Shona): "At the hospital I go to, the bed is too high for disabled women to climb. Especially the delivery beds. Disabled women are always afraid that their baby would fall off the bed."

We have already mentioned the need for special attention to those among the disabled people who are "further disabled" on account of their lower standing in the social hierarchy. WWDs and CWDs belong to this category. In some societies, women eat after men have had their fill. In others, children are given only what is left over, and often there is nothing left over. In many cultures women and children are "owned" by men as means of production. WWDs and CWDs in such societies are therefore doubly disadvantaged: first as women and children and secondly as disabled people.

At the Entebbe Workshop, the question of empowering women was discussed at length. A working group on the subject made several recommendations, which we summarise below:

· Women need to build their confidence. They should choose their own leaders, and not vote for men in influential positions. Women should be ready to grab power because nobody will give power to them freely. [The International Labour Office (ILO) has a guideline which stipulates that there must be at least 50 percent women as participants and beneficiaries of any project.]

· Organizations of PWDs and those working with them must give at least 50 percent representation to women in decision making bodies.

· It is sometimes assumed that when women get involved in IGPs, they automatically get empowered. There are other forms of empowerment such as legal, which should go with economic empowerment. One of the major strategies to empower women is through education and skills training.

· Women should demand for their rights and should form groups, clubs and working committees. They should struggle to get education and to attain equality.

· African cultures and religions, as practised today, oppress women. Women do most of the household chores while men relax: they work twice as hard as men. Therefore, there is need to reform religious and cultural practices so that women are empowered.

· Women should not limit themselves to "traditional" types of activities, such as secretarial work. They should look into possible new opportunities such as electronics, radio repairs, computers, etc.

Marginalised Disabilities

Some disabilities are more "disabling" than others. The blind and deaf, for example, face more severe communication barriers than those who are physically impaired. These barriers make participation even among the PWDs difficult. Furthermore, there is a disproportionately high representation of persons With physical disabilities in organisations of PWDs as members and leaders. When negotiating for resources, the blind and deaf are often viewed with misgivings. There is, therefore, need to improve the conditions of living, access to resources, and means to facilitate participation (braille and the sign language) for these people.

In the case of the severely disabled people, it is important to recognise the role played by their "carers" who can articulate their needs as well as provide love and daily living care and facilities, often at the sacrifice of their own economic well-being. Organisations of PWDs as well as governments should adopt positive discriminatory measures in favour of the severely disabled persons and their caters.

Question of Affirmative Action

We come now to the issue of "affirmative action," or "positive discrimination" as it is sometimes called. The arguments for it are familiar, and they boil down, essentially, to this: "Equal treatment of unequals is itself unequal."

The ILO position on this is that it must "...establish as a social policy the target that the rate of unemployment amongst the disabled persons should be no higher than the respective rate of the general workforce." 1

Equal treatment of unequals is itself unequal.

For example, under "equal conditions" a race between a one-legged person and a two-legged one is unequal. The chances are automatically loaded against the one-legged winning the race. Therefore, to "equalise the conditions" the disadvantaged should be given a head-start. In other words, there should be a policy of "positive discrimination" in his/her favour.

It is now a "standard" social policy to recognise the merits of "affirmative action" in favour of those who are disadvantaged either by history (the black community in South Africa), or by circumstances (the poor, for example), or by disabilities (the PWDs). There are, however, practical aspects that remain controversial.

How much discrimination should there be in favour of the disabled people?

For example, everybody is in the same boat as far as unemployment is concerned. Should the PWDs be given a preferential treatment over and above the non-disabled persons? What the ILO says in the above quotation is that the disabled people should not be given a preferential treatment as far as employment is concerned, but that they should, equally, not be discriminated against in terms of job placements, and job opportunities.

If "positive discrimination" is to take the form of, for example, a wage subsidy to the employer for taking on a PWD on a job, how much should this subsidy be? And for how long?

These are the kind of practical issues that arise in administering a policy of "affirmative action" in favour of any group of disadvantaged people, and not just the PWDs. But some of them cannot be answered in general terms; they need to be considered in concrete situations.

Action guidelines

A. For Persons with Disability

They must:

· Understand that they are first and foremost their own redeemers.

· Analyse the specific barriers to their advancement in their own concrete situations.

· Not rely too much on government. However, they must try to understand the dynamics of Structural Adjustment Programmes, and how the Social Dimensions Fund operates to cushion the effects of SAP, to be able to take advantage of it.

· Network with other grassroots organizations to brainstorm about alternatives to SAPs as a way of developing the national economies.

· Lobby the government for their legitimate rights in general with the rest of the population, for often they are deprived of these general rights.

· Analyse the situation of those amongst them who might be even more marginalised on account of their sex. age and disability. They must help create equalising opportunities for women and children and people with marginalised disabilities.

B. For the Government

The government should:

On matters of policy and Legislation:

· Take affirmative action, especially on education and job placements, including, where possible, subsidies to employers who employ people with disabilities

· Provide concessionary loans to PWDs and caters of people with severe disabilities to start income generating projects

· Recognise the right of children with disabilities to attend mainstream schools

· Provide subsidies to families with disabled persons (children/adults).

On information and referral facilities:

· Provide facilities for the PWDs to acquire simple (and in local languages) practical yet comprehensive information about matters that concern PWDs

· Provide adequate extension backup and referral services

On appropriate aids for PWDs:

· Subsidise the production of appropriate aids
· Remove taxes on imported appropriate aids
· Help with the procurement of equipment and machinery needed in IGPs (eg for agriculture)

On empowering local authorities:

Since most of the activities of concern to PWDs take place at the local level, the central government should empower local authorities and line ministries with authority and resources to facilitate PWD-sensitive programmes.

C. For the Community

The community should:

· Promote and facilitate the participation of PWDs in joint ventures
· Take affirmative action on developing positive attitudes towards PWDs

D. For the NGOs

The (NGOs) should:

· Establish programmes in consultation with PWDs on the basis of assessed needs
· Ensure sustainability of PWD programmes
· Decentralise decision-making
· Promote dialogue with project beneficiaries.

Some Areas of Further Debate

Does the Structural Adjustment Programme really provide an answer to the economic problems we face? What other alternatives do we have?

In what particular areas of Government action is a policy of "positive discrimination" in favour of the PWDs justified?

In what ways is African culture a disenabling factor for women and children? Should WWDs join with mainstream women's movements to fight for their general rights, or should they form their own separate organizations?

Appendix 1: Structural adjustment programme (SAP) - The experience of Zambia

[This appendix is added for those PWDs who take an interest in macro-level economic policy Issues, and who would like to look a little more closely on how the Structural Adjustment Programmes are affecting the economies of their countries.]

Zambia got into economic difficulties during the decade of the 1970s - largely on account of externally related factors, such as falling copper prices and the deteriorating terms of trade. The government concluded a two-year "stabilization programme" with the IMF in 1978. Instead of stabilising the economy, the situation worsened. Inflation accelerated even faster and this severely hit all fixed-income earners, especially wage workers.

In 1981 and again in 1983 Zambia concluded "extended fund facility" agreements with the IMF. However, because Zambia could not conform to the rigours of IMF's "eligibility criteria" only SDR 375 million were disbursed out of over SDR 1 billion that was negotiated. In 1986, in an attempt to meet with the IMF's conditionalities, government reduced the mealie meal subsidy and this led to food riots in the Copperbelt and the death of fifteen people by police action. On I May, 1987 government suspended the SAP.

For two years - from May 1987 to July 1989 - Zambia decided to go on its own - "growth from our resources" strategy. The New Economic Recovery Programme (NERP), as it was called, introduced major policy changes, including diversification, inflation control, rationing of foreign exchange, and reduction in import dependence. The economy improved remarkably. Agriculture grew at 21 percent and manufacturing at 15 percent, and the overall GDP growth rate was 6.7 percent against the planned target of 2.2 percent.

The Empire Strikes Back!

Over the last two decades the third world have been paying out an average of almost US$ 50 billion a year in NET TRANSFER OF FUNDS to the developed countries. In other words, it is not the North that is giving "aid" to the South; quite the opposite. The transfer of resources is from the South to the North. This figure must be augmented ten times if you put a "fair value" to the exports of third world raw materials to the North.

But then the creditors came knocking at the door. The IMF and the World Bank demanded payment of the accumulated debt of SDR 5.7 billion, plus SDR 1.2 billion in arrears and interest. 83 percent of total export of goods and services went simply to service these debts. In other words, for every dollar worth of all the copper and other things Zambia exported, only 17 cents came back to the people of Zambia and 83 cents went to foreign creditors. At the same time, all other donors - including those who claimed to be "friends" of Zambia - cut off aid to Zambia. They said they would bring in their capital only if Zambia returned to the IMF/WB.

Zambia was on its knees. In July 1989 Zambia abandoned NERP, and came back to IMF/WEB's Structural Adjustment Programme. In June 1990, the government, in order to meet IMF's conditionality, reduced maize meal subsidy. There were food riots for two weeks which spread from Lusaka to Kafue and Kabwe, and 26 civilians and a policeman died. On June 30, 1990, there was an attempted military coup. There was little the government could do to help the people. In the 1993 elections, people voted Kaunda's government out of power, and put in saddle an old trade unionist, Chiluba, hoping he would give people what Kaunda could not.

But Chiluba's hands are as much tied as Kaunda's. The World Bank, the IMF and the creditors have regained control over Zambia's economy. Under the new government, payment of arrears to the IMF were cleared by the 'Rights Approach" - whereby arrears are cleared only as long as Zambia successfully implements the SAP conditionalities on an annual basis. To enable this, government has "liberalised" trade, investment and dividend remittances. It has cut down on health and education. It has devalued the Kwacha in order to encourage exports, and to attract foreign capital. It is selling off state controlled enterprises (the collective assets of the people) to the "private sector," but since only the foreign private sector has the capital to buy these, the economy is in the hands of large foreign corporations more than ever before. The selling off of these assets has given a temporary relief to the economy by injecting more money into it. But it is temporary. Prices have started soaring again. Shortages are back again. Unemployment is increasing. The "Informal sector" of the economy now provides some 75 percent to 80 percent of the population. Back to the old days!


From the government level, we now come down to the level of the communities among whom the people with disabilities live. But this time we begin with a poem.

The poem is a statement of support for CBR -Community Based Rehabilitation. Insensitive attitudes and prejudice against persons with disability lie at the root of the predicament of the PWDs. These prejudices have tended to separate the disabled people from the community, and sometimes families, from which they have a right to expect love, shelter, patience and attention. They have to be "next to you not far".

Practices in relation to the PWDs

Past and present practices in relation to the people with disabilities fall into six distinct categories:

Isolation: The worst practice is isolation. It is a form of rejection. It is the denial of the very humanity of the person, especially so of people with disabilities arising from illnesses such as leprosy, epilepsy and mental impairment.

Get it from the horse's mouth

Is it true that you want to know?
Do you want to know about disability?
Do you want to know about disabled people?
What do you really want to know?
Why not get it from the horse's mouth?

I am physically disabled I need love,
I am blind I need shelter,
I am mentally disabled I need patience,
I am deaf I need attention,
Now you are getting it from the horse's mouth

It is not enough I have more.
I need education for my future.
I need to be employed for my future.
I need to be encouraged by you.
Now you are getting it from the horse's mouth

No, I am not through
I need to be next to you not far.

Girlie Hlanze, Swaziland

Practices in Relation to PWDs



Institutional Welfare

Educational Approach

Medical Approach


Overprotection: This, too, is a form of denial of the personality and capability of the person with disability. You can suffocate a person with excess love and sympathy. The effort to secure independence from family is sometimes almost like fighting a liberation struggle.

Institutional welfare: The more liberal forms of isolation take the form of special treatment of the PWDs in rehabilitation centres. These include both state institutions as well as those set up by (NGOs) especially the churches. This involves considering PWDs as objects of charity an welfare. Although justified in special situations, its more generalised application to all the disabled persons constitutes a gross insensitivity to those amongst them who, with support, can look after themselves.

Educational approach: Traditionally, governments and (NGOs) have tended to reinforce the isolation of children with disabilities by establishing special and separate educational institutions, such as schools for the deaf and the blind. Unless absolutely necessary, e.g., for purposes of learning braille, the aim should be integration within the mainstream.

The medical or professional approach: Once again a case can be made for certain kinds of disabilities that can be helped or alleviated through short periods of physiotherapy, psychotherapy or communication therapy. But a wholesale application of the "medicalist" approach to disability is both harsh and harmful to the PWDs. It isolates the clinical aspect of disability from the whole physical, psychic and spiritual being of the PWDs, and must be avoided at all cost.

Community Based Rehabilitation (CBR): As distinct from the above practices, CBR encourages communities to accept PWDs as integral members of society.

This chapter focuses on CBR, not in order to exalt its virtues in comparison to other approaches but in order to look at it critically in the light of some practical experiences. The other objective of the chapter is to examine what facilitative (or enabling) role the community can play in relation to the disabled people, in the light of our discussion on the "enabling environment" in the previous chapter.

What is CBR?

CBR is an approach of rehabilitation, equalization of opportunities, and social integration of all people with disabilities within community development. It is implemented, using locally available resources, through the combined efforts of the disabled people themselves, their families and communities, and the appropriate health, education, vocational and other social services.

Let us break this broad definition into specific goals.

What do we want to achieve in CBR?

We want to achieve:

· The full social integration of persons with disabilities within their communities;

· Disability prevention in Primary Health Care (PHC) activities, and rehabilitation to minimise the disabling conditions and barriers;

· The integration of disabled children into mainstream schools,

· The removal of social, institutional and attitudinal barriers to the opportunities for gainful economic activities for PWDs; and, all this leading to the self-realisation and self-empowerment of PWDs.

How do we go about it?

It is, essentially, a participatory approach in which persons with disabilities working within their communities develop their own strategies to enable them to fully participate in the mainstream of community life by:

· building their self-confidence;

· promoting horizontal, multi-sectoral coordination and cooperation;

· using locally available resources (material and human);

· developing a positive attitude among both able bodied and people with disabilities towards one another through sensitization programmes;

· providing information and raising awareness about disability issues to the communities;

· demonstrating the abilities, skills and contributions of PWDs;

· providing appropriate aids and equipment; and

· equalising opportunities of access to education, health, skills training, employment, recreation, social and cultural life.

These are broad guidelines. They may not apply to all situations and in all circumstances. Much depends on the communities themselves:

· their location (whether rural or urban);

· their cultural, religious and traditional heritage;

· the availability of local resources;

· the degree of unity within the community;

· the skill and wisdom of community leadership, including those who can provide leadership from among the disabled people themselves;

· the type of disability that predominates in the community (for example, river blindness); and so on.

There is no one ideal model.

Various Models of CBR

Community Rehabilitation Village (CRV)

Community Integrated Program (CIP)

Neighbourhood Day Centres (NDC)

Outreach Mobile Team (OMT)

Family-Based Rehabilitation Program (FRP) Outreach Support

Mawotto's ferry boats. (Photo by Thad Kaminski)

Given the diversity of the above factors, all kinds of combinations are possible. For example, a village steeped in the Islamic tradition would have one approach to CBR compared to another where mixed religions and mixed cultures coexist. Below are some possible models or scenarios that might apply to some situations but not to others. Again, we place it in a continuum showing there are no walls that separate one model from another, and that each approach could start with one model and move into another.

The continuum has on its left the most comprehensive approach - Community Rehabilitation Village (CRV) where the whole village or community is involved in the rehabilitation process. At the extreme right then, we have a family based rehabilitation programme (FRP) with some outreach support from outside. In between are some intermediate approaches.

The Community Integrated Programme (CIP) is a variation of the CRV whereby the PWDs and the able-bodied in a community are collectively involved in a joint project, for example, a communal garden to ensure village food security and storage.

The Neighbourhood Day Centre (NDC) rings together people with different disabilities, and sometimes carets, to a common location within the community to work, counsel each other, gossip and rejoice together. The important thing is that they go back to their respective families and thus are not isolated.

The Outreach Mobile Team (OMT) is a rehabilitation outreach programme whereby specialist staff from a nearby institution such as hospital or school visit individual homes, day centres or clinics.

As we said earlier, and it needs repeating, these approaches are not mutually exclusive. CRV and CIP can go together. CIP and FRP can go together. And the OMT can apply to all situations. What models or combinations are designed entirely depends on the people themselves using the "participatory" approach, and the circumstances of each situation.

We must repeat that there is no "ideal model", and the attempt to create one will turn it into yet another "institutional structure." However, it is important that for purposes of sustainability, whatever approach is adopted, it has the backing, support and involvement of the community.

Case studies

Mawotto Lake Transport Project, Uganda: A Case Study of CRV

Mawotto is a little peninsular village on Lake Victoria in Uganda in the sub-county of Ntenjeru in the District of Mukono. In its sunny wave-swept shores live a community of about 70 households, including 12 families of the blind. Most of these families were trained in agriculture at the Salama Agriculture Training Centre. The Centre was started in 1956 by Sir Cruther Mackenzie, himself blind, from New Zealand. Mawotto was selected as a settlement area for the blind by the Uganda National Association for the Blind (UNAB).

Terri and her husband Stanlake are both totally blind. Terri is from Teso District in the north of the country, and Stanlake is from Mukono District in Buganda, and they met at the Salama Training Centre. Terri lost sight at the age of one year because of measles ("I am lucky," she says, "I've no idea what sighted means.") Stanlake lost his sight when he was eighteen. They have four children, all sighted and now grown up. Musoke, 20, deals with the fishing project of the village; Robina is 16, Michael 14, Omonding 10, and they are all at school Terri herself teaches at the local school where all the children are sighted. "How do you do it?" I asked in wonder. "There is no problem, somebody helps me to write on the blackboard, "she laughed. Stanlake works on the farm. "We use the same tools as the sighted," he replied in answer to my question, "only the technique is different. Our rows of maize and potatoes and beans are even more straight and neater than those of the sighted, "he teased. Stanlake is also the Chairperson of the Mawotto Branch of UNAB.

With the help of UNAB, the blind families started the Mawotto Lake Transport Project. The idea was to ferry people across from the village over to the other side of the Lake into Kampala. A feasibility study was done. Some members got training in project management. They applied for funds from the African Development Foundation (ADF) to purchase boats and other equipment, and to their pleasant surprise they were successful.

Two more projects were added: a piggery ("the second best in the District of Mukono"), and farming. Now they have food to eat and the surplus is sold to generate cash.

"We have the same problems as those who are sighted," the chairperson explained, "Some people from Kampala are cutting down our trees for commercial purposes. The hungry monkeys are now descending to feed on our maize. Also, on account of some pest in the soil our bananas (matoke) are not growing well. We have to solve these problems together." "Yes," another member added- "Charles is a member of the RC 1. Whenever we have a problem, we mobilise the RC (Resistance Council) system."

When asked "How are you linked with the rest of the community?" one of the members of the Mawotto Branch Committee of UNAB replied: "Two of our members are teachers; in fact, Byekwaso, our Project coordinator is the chairperson of the Parent-Teacher Association of the school." A female member of the Committee added that a blind person is the chairperson of the Women's wing in the village.

Here is an example of a CRV type of CBR fully in operation. The blind live and work within the community, sharing its pains and pleasures. They are fully integrated into the life of the community, doing their own things quite independently and yet in partnership with the rest of the community.

Bwaise, Uganda: A Case
Study of NDC, OMT and CIP

In the outskirts of Kampala not far from the citadel of learning (Makerere) and the country's national hospital (Mulago) lies a peri-urban sprawl of crowded tenements of people trying to make a living on the edge of history. Not that the owners of the shops that line the main street with open drainage are poor. They are rich, but they don't live in Bwaise (for that is the name of this shanty town), they only come there to collect their profits. Behind the shops, in ramshackle dwellings erected hazardously on a swampy terrain live the real dwellers of Bwaise. They are frequently water flooded. Rubbish heaps abound. Mosquitoes thrive. Inevitably, there is malaria which affect especially children with cerebral malaria that results in brain damage. These must be among the poorest people in the world. And amongst them those with disabilities (of all kinds) must survive through sheer force of will.

Simon Lutaya writing with his toes. (Photo by COMBRA)

They are facilitated by an organization called COMBRA - Community Based Rehabilitation Alliance - founded by two determined health workers, a dedicated former nurse and a physiotherapist of Mulago Hospital working initially as volunteers in their own time. COMBRA has now become a recognised institution for training in the CBR approach to disability. They now offer course "modules" in CBR management and management of specific disabilities. The courses are based on a combination of theory (12 weeks) and field work (4 weeks).

Each trainee is allocated two families who have a member with disability in Bwaise. The trainees come once a week to visit the families of the disabled persons, and they practise hands-on assessment, counselling and therapy. Since their founding in 1990, COMBRA has trained 50 community workers in CBR. They have lost 10 to some donor-funded organisation that paid them enticing salaries to do research on AIDS. Of the others, five work as CBR volunteers with COMBRA.

Simon Lutaya of Bwaise

At Bwaise itself, COMBRA has set up a clinic to attend to people with disabilities. At the time of the author's visit there, the clinic had 78 PWDs and 160 elderly people on its register. Next to the clinic is a Day Centre -Tuesdays for the elderly, and Thursdays for the PWDs. Whilst some are engaged in handicraft at the day Centre, others come to talk, to dance and to make music. A physiotherapist comes once a week to give therapy and to monitor progress. Friday is the day of referrals, when some of the more serious cases are taken, by bus or by taxi, to the nearby Mulago hospital.

To witness one of their "successes" they took the author to visit Simon Lutaya. He was born prematurely and later developed cerebral palsy. For nine years he was not even brought outside the house. He is now 14, goes to school, and writes his name using his toes. He now has a wheel-chair, and although, with his father dead and his mother sick, the future does not look assured, Simon exudes a spirit of amazing self-confidence.

Among COMBRA's successes are the following:

· Early identification of problems
· The outreach clinic
· The referral system
· A change in the attitude of the community
· Building a sense of hope and confidence among the PWDs
· Integration of disabled children in mainstream schools
· Promoting sustainable income generating activities

A general assessment of CBR: Possibilities and limitations

At the Entebbe Workshop the issue of CBR generated much discussion. Since many of the participants had hands-on experience with CBR projects in their own countries, they were able to summarise their experience thus:

Positive achievements of CBR

· It has helped create self employment

· It has built up self-confidence and reduced dependence and begging

· It has positively changed the attitude of the community

· It has stimulated development

· It has integrated PWDs into the social and economic development

· It has encouraged funders to support more community based activities.

· It has enabled people with disabilities to display their talents within the society while participating in income generating activities.

· It has utilized locally available resources

· It has helped transfer skills and appropriate technology

· It has created sustainability by developing society's capability.

· It has reached the hitherto unreached.

What then of its limitations?

Most of the limitations arise, the participants suggested, because of the general level of Poverty and literacy in many countries in Africa. Given these, if not properly planned and implemented, CBR could develop several problems. The following are some of these.

· It could turn into a top-down and technicist project.

· Imposing the project on the PWDs (by community leaders, professionals, or the donors) without their active participation and involvement

· CBR may not be the priority of the community and may compete for scarce resources, and this may therefore constrain its viability.

· Many CBR programmes focus on the medical model with emphasis on children's disabilities. The vocational, educational and employment components get neglected.

· Within integrated groups, suspicion may exist among the PWDs that they are being manipulated and used by the non-disabled persons.

· Lack of funding/resources for CBR projects could create problems of sustainability.

· Donor resources can undermine local initiatives and resources.

· Politically motivated projects aimed at securing political support could affect CBR negatively - [e.g. a wheel chair donated to a deaf person by a politician who had no knowledge of the latter's needs.]

· Difficulty of coordination arising out of lack of cooperation from the individual, family or the community.

· Difficulty of sourcing expensive appliances needed to fully integrate the PWDs into integrated projects.

· Duplication of community services by various extension workers from other programmes.

· Insufficient number of adequately trained CBR community workers could lead to poor conception, implementation and supervision of projects.

· CBR is still viewed by many DPOs as a foreign concept, and this has made its acceptance difficult.


In spite of the limitations, CBR, most people agreed, is still the most cost effective approach. It can help facilitate independent living for persons with disabilities drawing on the resources and the support structures of the community. For CBR to be successfully implemented, the following areas of activity and concern have to be built into the CBR-based programmes.

· Vocational training and loan schemes for income generating activities of the PWDs so that CBR projects can be self-sustaining. [The Mawotto project is a good instance of this.]

· Assistive aids need to be procured without straining the resources of the community whilst not creating a dependency syndrome.

· Awareness campaigns within the community can help to avoid top-down and technicist approaches.

· Self-representation by persons with disabilities is an important element in project planning. They should include the severely disabled people or their carets, who are often left out of project planning.

· CBR projects should be backed by affirmative policies and strong legal mechanisms for enforcement.

· As far as possible CBR should be based on the use of local resources, with outside assistance considered as supplementary.

Action guidelines

A. For Persons with Disability

They must:

· Organise themselves to advance their own case

· Consider the possibilities of CBR with an open mind

· Develop leadership amongst themselves

· Fight against prejudice and discrimination

· Lobby government to adopt 'WHO and ILO Conventions

· Raise awareness of all those around them on the attitudinal and institutional barriers against their integration

· Overcome fears against prejudices that marginalise them

· Insist on mainstreaming their activities, and not be treated to isolationist programmes

· Insist on the participatory approaches to planning of programmes and projects

· Build broad solidarities for action, and build active networking strategies

B. For the Community:

The community should:

· Encourage progressive change in the attitude towards PWDs. Integration should be sought not for its own sake but also to change the environment. Integration must be undertaken in an interactive manner. The PWDs also have a lot to contribute to the community. It is not a one-sided affair.

· Work towards full participation of the PWDs, so they recognise themselves as part of the community.

· Prepare itself to integrate the PWDs in their regular development efforts. Build upon community institutions. Identify and actively overcome institutional barriers.

· Encourage "Practical skills" among the able-bodied people: to listen to be sensitive to the needs of persons with disabilities to wait to be asked for help, or ask if help is needed to restrain from being overprotective to facilitate accessibility

· Modify physical and architectural aspects of public facilities [e.g. toilets, doorways, switches].

C. For the Government

The government should:

· Facilitate the integration of disabled children in mainstream schools.

· Provide for the training of PWDs with skills that would enable them to live amongst their communities with dignity; and, where possible, this training be integrated with able bodied persons.

· Facilitate the acquisition of appropriate aids for people with disabilities to take on gainful occupation within the communities

· Recognise the work done by (NGOs) in the field of CBR and support their efforts, for example, through enabling them to import equipment and tools without import duties.

· Provide guidelines and monitor the activities of (NGOs)

· Provide adequate backup and referral services in government hospitals and village clinics.

· Provide adequate extension services to CBR projects of disabled peoples that are based on agriculture, livestock management and fishing.

· Provide basic management skills and extension services to PWDs to enable them to run their businesses.

· Empower local authorities with finance and enabling legislation to facilitate CBR programmes.

D. For IGOs, INGOs and (NGOs) working with PWDs

They should:

· Be sensitive about matters of concern to the PWDs in their development programmes

· Involve the community in the planning and implementation of development projects.

· Ensure active participation of PWDs in development projects.

· Play a facilitative, not directive, role

· Be cautious about killing local initiative through overfunding or through creating false expectations

· For proper coordination, the local and international (NGOs) need to consult with one another before getting into a CBR project. The consultation must continue on a regular basis.

Some issues for Further Discussion

The communities in Africa are already impoverished as a result of global economic dynamics - such as SAPs and now the effects of the Uruguay Round of trade agreements. How can they and the PWDs who live among them take up these new challenges?

There is need for further discussion on the division of responsibilities between the various stakeholders: the disabled persons themselves, the families, the Government, the local community, the international community, the NGOs, the funders, etc. How can this discussion be facilitated?

How well equipped are NGOs (even those of the disabled persons) to manage CBR programmes? How do we further the empowerment of the PWDs within the NGOs?

Are there specific concerns which women (PWDs and able bodied) in communities with CBR programmes have to address? What are these issues, and how might they be addressed?

How well equipped is the CBR approach in catering for the severely disabled persons, their carets, and other marginalised disabilities?

Does the current CBR training and curriculum cater for adequate human-power development?