SERVICE DELIVERY, COMMUNITY DEVELOPMENT AND DISABILITIES
One of the greatest hurdles disabled people face when trying to access mainstream programmes are negative attitudes. It is these attitudes that lead to the social exclusion and marginalisation of people with disabilities. Negative attitudes are continually reinforced. Disability is portrayed as a 'problem'. People with disabilities are viewed as helpless and dependent; as ill and in constant need of care and medical treatment, or as tragic victims. Culture plays an important role in the way we relate to people with disabilities. This contributes to the perception of people with disabilities as different or 'outsiders'. The changing of attitudes is not something that happens automatically or spontaneously. Attitude changing is complex processes which involves moving, in a series of stages from one set of attitudes to another .Public education and awareness are central to the changing of attitudes.
Rehabilitation is the word used to describe ways of helping people with disabilities to become fully participating members of society, with access to all the benefits and opportunities of that society. This means that disabled people should have access to such benefits as early childhood development opportunities, education and training opportunities, job opportunities, and community development programmes. Rehabilitation services have traditionally been neglected in South Africa. Predominantly based within the health sector, with the Departments of Labour and Education carrying some rehabilitation related programmes, these services tend to be fragmented and uncoordinated. This is due mainly to the lack of a comprehensive national inter-sectoral rehabilitation policy.
The Social Model of disability proposes a more central role for disabled people in the planning, development, implementation and monitoring of rehabilitation services. There will, in other words, be a shift in power away from professionals towards people with disabilities.
To achieve its aims, the rehabilitation process requires a number of supportive services, but its impetus must come from community action and involvement. Community-based rehabilitation should, therefore, form the basis of the national rehabilitation strategy, supported by secondary and tertiary rehabilitation services as proposed in the Health Department's Technical Committee on Rehabilitation Policy. New labour, social welfare, education and health policies will also have an influence on the scope of rehabilitation in this country.
Social Welfare and Community Development
The social worker's office is a key access point to the service-delivery system for a large percentage of people with disabilities. Unfortunately, the fragmented nature of the service-delivery system often leads to a lack of effective referral to other sectors. This means that the social welfare system has to deal with education, employment, transport and housing related issues. Changing the way people regard disability from a purely health and welfare issue to a primarily human rights and development issue has significant implications for the principles, objectives and goals of existing welfare services. It implies that welfare services need to be designed to facilitate independence in society, rather than dependence on welfare services.
The majority of people with disabilities live in areas which are regarded as the most underdeveloped and poverty-stricken in South Africa. Community development acts as a tool to alleviate poverty by increasing the capacity of people to influence their future. It is therefore a key component of any social welfare system. Programmes and projects should be aimed at achieving physical and concrete changes in a way that gives people greater capacity to choose and respond to these changes. Community development initiatives should foster human solidarity, social equity, self respect, respect for diversity and continuing activism.
Community development strategies should be based on the following cornerstones:
The support for and strengthening of disabled people organisations. The participation of all sectors of society in all community development initiatives, i.e. integrated community development processes.
Social Welfare Services
Social welfare services should include a range of strategies designed to facilitate access by people with disabilities and parents of disabled children to mechanisms which will enhance their ability to live independently.
Social welfare services include:
Residential care services for people with severe disabilities who, as a result of their disability, are in need of permanent specialised care. This includes care for elderly people with disabilities. A move towards units that are more open, smaller and based within the community should be encouraged. In this way, residents can enjoy some degree of independence and privacy. Large institutions for people with severe disabilities. A number of people with severe disabilities presently reside in large institutions run either by subsidised welfare organisations, the private sector or the state. While these institutions provide shelter and necessary care for people who would otherwise have struggled to meet their needs, they present a number of significant problems.
Conditions in these institutions range considerably and, although all institutions are required to meet minimum standards, some fall short of basic requirements and indeed violate human rights principles. This situation has been allowed to continue for the following reasons: lack of affordable accommodation; inability of family members to provide continued care without any community-based support services, resulting in rejection and 'dumping'; inadequate and ineffective subsidisation and regulatory systems; lack of representation on management structures by either residents or their families or advocates: poor financial and managerial skills. This places disabled residents in an extremely weak and vulnerable position, with little recourse to change. Personal assistance services enable people with severe disabilities to direct their own lives and to exercise their rights to choice and dignity within their own homes: in other words, to be able to choose what to do, when to do it, how to do it and with whom to do it. Personal assistance services also contribute to the prevention of secondary ailments and illness, and facilitate de-institutionalisation. Activity centres for disabled people, who, due to the severity of their disabilities, are unable to engage in any meaningful economic activity. Services should include a range of options which allow as independent a lifestyle as possible; promote full potential and dignity, and facilitate the involvement of families and communities in the provision of services.
Underlying causes of the current state of service provision (Chapter 5)
There are factors, in addition to the historical legacy of apartheid, that constrain the provision of services for children with disabilities in South Africa. These include attitudes of society and service providers, gaps in legislation, policies and budgets.
South Africa does not yet have a standard/nationally accepted measuring tool in line with the ICF. Estimates of child disability prevalence generated from various sources are therefore not directly comparable because of different definitions of disability and methods of data collection. Moreover, while the Census and other national household surveys do include general questions about people with disabilities, these questions were not specifically designed to identify children with disabilities. Although a shift has been made at policy level from an approach based on the medical/welfare model of disability to one based on the social model (which sees disability as a human rights issue),7 this is often not reflected in the attitudes and approaches of service providers and society at large. Adults and children with disabilities are frequently viewed by society as objects of pity and deserving (only) of charity.8
Children who participated in the focus group discussions that formed part of the study reported that people’s negative attitude towards them was one of the most difficult things for them to deal with. Their greatest dislikes were being laughed at, being called derogatory names and being teased about their disabilities.
Policies and plans
Inadequate alignment of policies to plans of Departments continues to undermine the pace of service provision. There are numerous policies in place that are intended to fulfil government’s constitutional and legal obligations towards children with disabilities. However, these have not been consistently linked to national and provincial planning processes. For example, despite the clear statement of priorities in White Paper 6 on Inclusive Education, a review of strategic plans of the Department of Basic Education at the national and provincial levels reveals inadequate provisions to support children with disabilities. Again, although the National Rehabilitation Policy is in place, the Department of Health’s strategic plans reviewed as part of this study (at the national and provincial levels) make little reference to this policy or to the Policy on Standardisation of Assistive Devices. The Strategy for the Integration of Services for Children with Disabilities cites the Department of Social Development as one of the lead departments in the provision of facilitation and rehabilitation services for children with disabilities but neither national nor provincial strategic plans reviewed make clear provisions for implementation.
Furthermore, although the South African government has ratified the UNCRPD, and the former Office on the Status of Disabled Persons (now part of the Department of Women, Children and People with Disabilities) has developed implementation guidelines, 12 these are not clearly reflected in the strategic plans of particularly the Department of Basic Education and the Department of Health. Only the Department of Social Development makes reference to the UNCRPD in its national strategic plan. There are also difficulties related to monitoring of budgets for children with disabilities. The lack of specific information on service provision and related budget allocations appears to be a major barrier to the monitoring and protection of the rights of children with disabilities.
Service delivery environment
There is a need to create a sustainable environment for service delivery partners (non-profit organisations or NPOs) through “capacity-building, collaboration and agency” This requires the development of an effective service delivery model that ensures good planning, adequate funding, improved co-ordination and appropriate monitoring of implementation. Appropriate norms and standards should accompany this delivery model.
It is very clear that South Africa is still struggling to provide proper and adequate services to vulnerable groups. Another contributing factor is lack of funding or delayed funding for NGO”S that provide services in the communities. Community development seems not to be working since most services provided in the communities are not participatory hence communities are not developing in any manner.
Department Social Development (2009) Strategy for the Integration of Services for Children with Disabilities. Interdepartmental Task
Department of Social Development Strategic Plan 2010-2015.
Nkeli, J. & Associates (2008) Broad overview of the impact and an analysis of the effectiveness and efficiency of disability policy implementation in all spheres of government since 1994..
Office of the High Commissioner for Human Rights (2007) From exclusion to equality: realizing the rights of persons with disabilities. Handbook for Parliamentarians on the Convention on the Rights of Persons with Disabilities and its Optional Protocol.
Philpott, S. & McLaren, P. (2011) Hearing the Voices of Children and Caregivers: Situation Analysis of Children with Disabilities in South Africa. Pretoria: Department of Social Development/UNICEF. National Stakeholder workshop, 24 May 2011.