A Coordinated Collaborative Response to Rehabilitation Needs of Persons with Disabilities

Special Article - Disability and Rehabilitation

Phys Med Rehabil Int. 2015; 2(7): 1056.

A Coordinated Collaborative Response to Rehabilitation Needs of Persons with Disabilities

Ned L¹*, Mji G¹, Krige FK², Muller JV², Duvenage C², Runowicz A² and Joubert EM²

1Centre for Rehabilitation Studies, Stellenbosch University, South Africa

2Ukwanda: Centre for Rural Health, Stellenbosch University, South Africa

*Corresponding author: Ned L, Centre for Rehabilitation Studies, Stellenbosch University, P O Box 241 Cape Town 8000, South Africa

Received: July 30, 2015; Accepted: September 02,2015; Published: September 04, 2015


The full integration of persons with disabilities cannot be achieved by one sector because of the complexity of disability issues. Rehabilitation is one strategy that aims for the full integration of persons with disabilities in communities calling for integrated and collaborative inter professional and intersect oral approaches towards achieving this goal. This paper proposes an inclusive participatory process of a coordinated collaborative response to the rehabilitation needs of persons with disabilities as a model of best practice which is currently being piloted in a specific rural community in South Africa. Through this participatory process, the model demonstrates how the UNCRPD, CBR and ICF can be used and contextualised within a new inclusive development model in responding to both the cultural and contextual demands in communities, whilst also building the capacity of stakeholders who will be involved in participating in the implementation of this coordinated collaborative response to the needs of persons with disabilities in this specific area. At the core of this proposed model is the art of reclaiming the human dignity of persons with disability and facilitating empowerment through such collaborative spaces where persons with disabilities from the beginning form part of the discussions in the various stages of this proposed model and given the spaces to respond and inform the development of solutions that will have an impact in their lives. This state of the art innovative rehabilitation model of best practice is proposing the integration of the translation of the rights of persons with disabilities as well as the current rehabilitation theories and policies into the actual lived community experiences of persons with disabilities. The outcomes of this model are the principles of empowerment, inclusivity, collaboration and a socially responsive model of best practice that speaks and addresses directly and appropriately to the needs of persons with disabilities at community levels. We perceive that this model is the practical example where the expression coined by persons with disabilities- "nothing about us without us" is being practically implemented at ground level.

Keywords: Rehabilitation; Disabilities; Stakeholders; Human Dignity


In 2011, the Theology Faculty, the Centre for Rehabilitation Studies (CRS) from the Medicine and Health Science Faculty (MHSF) and Psychology Department of Stellenbosch University (SU) collaborated and hosted a conference with the theme- Disability, Theology and Human Dignity. This was a fist for SU as the first international interfaculty conference. The 3rd day of this conference was held at the campus of the National Institute for the Deaf in Worcester with the goal of meeting with a group of persons with disabilities (PWDs) in Worcester. The rationale for this was to get an understanding from persons with disabilities from Worcester what are their needs and services as the MHSF at the time was busy developing a rural clinical school (hereby referred to as Ukwanda: Centre for Rural Health) in Worcester and was preparing to place medical and rehabilitation (Occupational Therapy, Speech therapy, Human Nutrition and Physiotherapy) students in the rural clinical school in Worcester. From this conference in Worcester, a 2 page list of needs (See a detailed list of needs in Appendix 1) was then developed and handed over to clinical facilitators of the above mentioned group of students that were going to be placed in the Ukwanda: Centre for Rural health in the following year.

In response to this 2 page list of needs of PWDs, an internal process was being developed within the CRS and the Ukwanda: Centre for Rural Health of SU to further discuss the issues of disability and human dignity within a broader university strategy. The Hope project, which is Stellenbosch University’s institutional response to issues of poverty and vulnerability in Africa chimes closely to some of the 2011 conference recommendations and the needs that had been specified by persons with disabilities (PWDs) in Worcester. Subsequent to this, the CRS started planning on how to ensure that clinical facilitators that are placing students in Worcester with the goal of responding to the needs of PWDs in that area are using the list to guide them in placement of students.

The CRS as a postgraduate study Centre that facilitates the development of models of best practice in responding to the needs of PWDs started designing a rehabilitation research response to the needs of PWDs in Worcester. To further respond to the two page list of the needs expressed by PWDs in Worcester the CRS drew in key stakeholders from Ukwanda Centre for Rural Health with the goal of fostering collaboration and developing a combined engagement and response to needs of PWDs in Worcester. The CRS then took the two pages of the needs and aligned them with the CBR matrix. The next step was to see how needs are also aligned to the 5 articles that underpin access to health and rehabilitation services in the UNCRPD. We also wanted to see if environmental barriers and personal factors further hindered access to services for PWDs. The rationale was to start developing a coordinated collaborative rehabilitation response to these needs expressed by this group.

a. Lately debates that have directed and driven the rehabilitation theory and scope of practice had centred around three international instruments: The International Classification of Functioning, Disability and Health (ICF) [1];

b. The Community Based Rehabilitation strategy (CBR) with its matrix and 4 Pillars (health, Education, Livelihood, Social and Empowerment) [2]; and

c. The United Nations Convention for Persons with Disabilities (UNCRPD) [3].

In addition to ratifying the UNCRPD, South Africa has developed some of the most progressive rights-based policies concerning disability and rehabilitation in the world. At national level, strategic policies include the Integrated National Disability Strategy, the National Rehabilitation Policy, the Education White Paper 6; the Disability Framework for local government 2009-2014 and at provincial level in the Western Cape, there is the WCED Disability Strategy.

Recently the National Department of Health had tasked a selected few of rehabilitation academics, Provincial rehabilitation managers and CEOs of disabled people organizations to develop a rehabilitation strategy and respond to the needs of disabled people in South Africa. At the core of these discussions is, how to domesticate (how to make these instruments relevant for the contextual issues of South Africa) the UNCRPD, the CBR guidelines and the ICF with the hope that these three instruments will assist in the development of a contextual relevant framework for rehabilitation in SA. The piloting of the UNCRPD, the CBR guidelines and the ICF as part of a response by the Ukwanda: Centre for Rural Health to the rehabilitation needs of persons with disabilities in Worcester could assist in strengthening links of Stellenbosch University with international organizations such as the WHO and the UN while also practically responding to the Health Department of South Africa’s need to domesticate the three instruments.

The Journey of Rehabilitation

Rehabilitation has long lacked a unifying conceptual framework [4]. The discourse was also subject to the changing theoretical and socio-political understandings surrounding disability. The World Report on Disability [5] reports on how historically, the term rehabilitation has circled around describing a range of responses to impairment, from interventions to improve body function to more comprehensive measures designed to promote inclusion. Rehabilitation services used to focus within a medical model approach where services were institutionally based and very individualistic in its nature of therapy rendered [6]. Within a medical model, the bodies of persons with disability were viewed as incomplete and needing to be fixed by those who were presumed to have the expertise and knowledge. Over the years, the social model brought a new paradigm shift in the construction of disability whereby a distinction was made between impairment and a disability [6]. Many scholars have highlighted that disability is not only about pathology and health but also about exclusion and discrimination imposed on individuals with impairment [7]. This is not negating the medical needs but there is a need to acknowledge disability as a political and human rights issue.

Recently, the World Report on Disability [5] positioned Disability as a complex multidimensional experience that poses several challenges for implementation of rehabilitation services. South Africa is one of the African countries that had ratified the United Nations Convention on the Rights of Persons with Disability (UNCRPD) Preamble [3] which acknowledges that disability is "an evolving concept" but also stresses that "disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others".

This view of disability as an interaction implies that "disability" is not an attribute of the person. Because disability is a social construct, as society continues to evolve with regards to its terminology and how it defines certain aspects- disability definitions will continue to evolve too. People with disabilities face various physical, social and attitudinal barriers to participation in their communities and access to vital services pertinent to their day to day needs [5]. These barriers have led to the development of national and international legislature to respond to the needs of persons with disabilities while also protecting and strengthening their rights as equal members of society.

The current guiding policies in South Africa are the National Rehabilitation Policy (NRP) of South Africa [8] the UN Convention on the Rights of Persons with Disabilities (UNCRPD) [3], International Classification of Functioning, Disability and Health (ICF) [1] and the Community Based Rehabilitation (CBR) Guidelines [2]. All of these policies and guidelines set out the objectives for effective and accountable rehabilitation services that include the full participation of people with disabilities in the planning, implementation, monitoring and evaluation of services.

The NRP aims to facilitate the rights for every citizen to have access to health and rehabilitation services to bring about equalisation of opportunities and enhancement of human rights [8]. However, Mji et al [9] bring to attention that there are still gaps in the implementation of this policy with no empirical evidence suggesting such implementation that is aligned with its objectives. Alternatively, the ICF provides a standard language and conceptual basis for measuring and defining disability. This framework makes awareness to both impairment and impact on activity limitation and participation restriction with cognisance to both the personal and environmental factors which can be both barriers and facilitators [1]. The question is how rehabilitation professionals are exposed to these critical elements of the ICF to be able to respond to issues of activity limitation and participation restriction (see Figure 1 for the ICF framework).