Sustainable Rehabilitation of Persons with Disabilities for National Development
Abstract
Persons with Disabilities (PWDs) are bona fide citizens in every country and as such have equal rights to development opportunities provided for other citizens of the nation. It is observed that a number of persons with disabilities have become a burden to the society, rather than contributing members of their communities and nation at large. This is because they have been neglected by society and the government has failed in its responsibility to properly empower and invest in them for national development. In addition, PWDs in some countries are negatively regarded as environmental nuisance and wastage in the society as many of them are involved in begging all because of lack of sustainable rehabilitation. In spite of the numerous challenges posed by the handicapping conditions, persons with disabilities are blessed with a wide range of skills and talents which are needed for utilization and national development. If persons with disabilities are to be transformed into productive and independent, rather than remain a burden to the society, by extension, development of the nation, then there is need to invest in and empower them. This is where the issue of sustainable rehabilitation comes in. Therefore, this article discusses the concept persons with disabilities, concept of rehabilitation, typologies of rehabilitation which entails medical, psycho-social, educational and vocational rehabilitation. The article also ends with a conclusion and recommendations.
Keyword: Sustainable, Rehabilitation, Programmes, National Development, Persons with Disabilities.
1. Introduction
It was widely reported that Persons with Disabilities (PWDs) are excluded from education, health, employment and other aspects of society and this can potentially lead to or exacerbate handicapping conditions (WHO, 2011). The United Nations (UN) Convention on the Rights of Persons with Disabilities states that “comprehensive rehabilitation services including health, employment, education and social services are needed ‘to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life” (UN, 2008).
Therefore, Rehabilitation is a programme geared towards enabling PWDs to overcome their challenges and move from dependency to independent status in the society. Rehabilitation is a programme planned for adults and children with disabilities to teach and train them to live a normal and productive life after they experience damage, defect or malformation of one more part of their bodies and aims to restore the individual to normal functioning. It is a process that occurs in specially designed procedures for PWDs to receive full restoration to overcome any handicapping conditions. This is done by teaching and training them to use their potentials and abilities optimally to function physically, mentally, socially, psycho-analytically, economically, etc. to achieve self-actualization. Therefore, rehabilitation services include everything done to help a person with disability to perform well enough to achieve independence. Likewise, a sustainable rehabilitation programme is a durable, workable and tenable programme geared towards removing or reducing the handicapping conditions which enables PWDs to overcome their challenges and move from dependency to independence, and become productive for national development (Jackson, 2009).
2. Theoretical Underpinning
This article is guided by a Community Based Rehabilitation (CBR) model as a new strategy used to provide rehabilitation services to persons with disabilities within and by their community and not in a separate institution.
2.1 Community Based Rehabilitation (CBR) Model
Community-based rehabilitation (CBR) is the strategy endorsed by WHO for general community development for the rehabilitation, poverty reduction, equalization of opportunities, and social inclusion of all Persons with Disabilities (PWD). CBR is implemented through the combined efforts of PWDs themselves, their families and communities, and the relevant governmental and non-governmental health, educational, vocational, social and other services. CBR is delivered within the community using predominantly local resources. The objective of the CBR strategy is to improve the quality of life for individuals with disabilities and their families, by doing their daily tasks independently, and by participating effectively in their community. CBR was created to empower people with disabilities to benefit from education, working positions, health, community, and social services. CBR relies on the cooperation between people with disabilities themselves to be implemented effectively. Also, their families, local communities, governmental administrations, non-governmental organizations, associations and other relevant services should take part in the implementation process (Davis, 2006).
Source: WHO (1980)
The CBR Matrix provides a basic framework for CBR programs. It highlights the need to target rehabilitation at different aspects of life including the five key components: health, education, livelihood, social, and empowerment. Thus, a CBR program is not expected to implement every component of the CBR matrix, and not all PWDs require assistance in each component of the matrix. However, a CBR program should be developed in partnership with PWDs to best meet local needs, priorities and resources. A health condition may lead to an impairment, which could restrict full participation in aspects of society, thus resulting in disability. Providing CBR may reduce some of the consequences of the impairment, by facilitating participation by PWDs in the domains of health, education, livelihood, social activities, and empowerment. CBR could therefore range from providing assistive devices in the community to increase mobility, to coordinating with local schools to ensure inclusion of children with disability, offering vocational rehabilitation to increase wage employment, family counseling to improve relationships, and the establishment of self-help groups to improve political participation. The outcomes of CBR will therefore vary depending on the targets of specific programs, but could include improving social participation, clinical outcome and quality of life among Persons with Disabilities (Davis, 2006).
3. Methodology
Secondary data were used for the writing of this paper. Secondary data has to do with documentary sources of data which include documents either hand written or typed, electronic or print, softcopy or hardcopy, published or unpublished. Therefore, books and published journal articles of various scholars, national and international documents were examined, reviewed and used in writing this paper, and they were duly acknowledged in an in-text citation and in a references list.
4. Conceptual Clarification
4.1 Concept of Persons with Disabilities
Disability is an umbrella term for impairments, activity limitations, and participation restrictions, denoting the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors) (WHO, 2011). Persons with disabilities (PWDs) therefore include those who have long-term physical, mental, psycho-social, intellectual or sensory impairments resulting from any physical or mental health conditions which in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others (UN, 2008). Persons with disabilities categories into the following:
Physical impairment is often the most easily identifiable and presents difficulty in the performance of bodily functions involving: movement and mobility (such as walking, climbing stairs, standing, or maintaining or changing position); body movements (such as reaching, crouching or kneeling); and using upper limbs (including gripping or using fingers to grasp or handle objects). Persons with physical impairments may use assistive devices including walking sticks, crutches or wheelchairs.
Sensory impairment includes vision, hearing and communication impairments.
Vision impairment includes persons who are blind and also people with low vision.
Hearing impairment includes Deaf persons, as well as people with hearing loss with some residual hearing. Depending on their situation, persons with hearing impairment may communicate through spoken language or use sign language and/or lip-reading to communicate.
Communication impairment includes persons with difficulty in speaking or with speech impairments who may require adapted communication techniques.
Intellectual disability includes persons with limited ability to understand new or complex information and to learn and apply new skills. This may impact three domains that determine how well an individual copes with everyday tasks: (1) the conceptual domain – skills in language, reading, writing, math, reasoning, knowledge and memory; (2) the social domain – empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities; and (3) the practical domain – self-management in areas such as personal care, job responsibilities, money management, recreation and organizing tasks.
Mental and psycho-social disability includes persons with impairments related to mental health conditions, including chronic severe mental disorders or psychosocial distress. These people may experience difficulties in relating to others; distressed moods or confused thoughts; an inability to take care of themselves; and difficulties related to behaviour, language and intellectual activities. These difficulties in turn may impact their social skills and participation.
4.2 Concept of Rehabilitation
Rehabilitation has long lacked a unifying conceptual framework. Historically, the term has described a range of responses to disability, from interventions to improve body function to more comprehensive measures designed to promote inclusion. The International Classification of Functioning, Disability and Health provides a framework that can be used for all aspects of rehabilitation. For some people with disabilities, rehabilitation is essential to being able to participate in education, the labour market, and civic life. Rehabilitation is always voluntary, and some individuals may require support with decision-making about rehabilitation choices. In all cases rehabilitation should help to empower a person with a disability and his or her family. Article 26, Habilitation and Rehabilitation, of the United Nations Convention on the Rights of Persons with Disabilities calls for: appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life”. The Article further calls on countries to organize, strengthen, and extend comprehensive rehabilitation services and programmes, which should begin as early as possible, based on multidisciplinary assessment of individual needs and strengths, and including the provision of assistive devices and technologies (Walker, 2005).
A modern healthcare system must do more than just stop people dying. It needs to equip them to live their lives, fulfill their maximum potential and optimise their contribution to family life, their community and society as a whole. Rehabilitation achieves this by focusing on the impact that the health condition, developmental difficulty or disability has on the person’s life, rather than focusing just on their diagnosis. It involves working in partnership with the person and those important to them so that they can maximise their potential and independence and have choice and control over their own lives. It is a philosophy of care that helps to ensure people are included in their communities, employment and education rather than being isolated from the mainstream and pushed through a system with ever-dwindling hopes of leading a fulfilling life. It is increasingly acknowledged that effective rehabilitation delivers better outcomes and improved quality of life and has the potential to reduce health inequalities and make significant cost savings across the health and care system (Stilwell, 2010).
Rehabilitation covers an enormous spectrum within our patients’ pathways. It includes support to learn basic communication skills; exercise classes to improve or maintain optimum health, wellbeing and occupation; and complex neurological rehabilitation following major trauma or stroke. Rehabilitation may be appropriate at any age as a person’s needs change through the course of their life. For example, they may require support to:
develop skills for the first time;
recover from unexpected illness;
manage long-term conditions;
self-manage conditions;
recover from major trauma;
maintain skills and independence;
access advocacy (Thomas, 2002).
Rehabilitation is “a set of measures that assist individuals who experience, or are likely to experience, disability [resulting from impairment, regardless of when it occurred (congenital, early or late)] to achieve and maintain optimal functioning in interaction with their environments”. This definition corresponds to the comprehensive process that contributes to health promotion and determines most Handicap International projects. It is therefore necessary to refine this definition to fit the activities developed as part of Rehabilitation Services Unit-supported projects. The WHO defines the individual in his environment as the centre of the rehabilitation process. “Individuals” should be understood to be not just those “who experience, or are likely to experience, disability,” but also their families, who can be helped to become actors in the rehabilitation process and benefit from the results achieved (Davis, 2006).
WHO (2011), defines rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”. A distinction is sometimes made between habilitation, which aims to help those who acquire disabilities congenitally or early in life to develop maximal functioning; and rehabilitation, where those who have experienced a loss in function are assisted to regain maximal functioning. In this paper the term “rehabilitation” covers both types of intervention. Although the concept of rehabilitation is broad, not everything to do with disability can be included in the term. Rehabilitation targets improvements in individual functioning – say, by improving a person’s ability to eat and drink independently. Rehabilitation also includes making changes to the individual’s environment – for example, by installing a toilet handrail.
Rehabilitation involves the identification of a person’s problems and needs, relating the problems to relevant factors of the person and the environment, defining rehabilitation goals, planning and implementing the measures, and assessing the effects. Educating people with disabilities is essential for developing knowledge and skills for self-help, care, management, and decision-making. People with disabilities and their families experience better health and functioning when they are partners in rehabilitation (WHO, 2011).
4.3 Sustainable Rehabilitation
Sustainable rehabilitation is conceptualized as a continuous programme of activities that involve accurate evaluation, appropriate education/training based on need and ends with full employment and monitoring for persons who face numerous challenges due to any form of disability. Sustainable rehabilitation ensures that nothing is left out in the efforts to enable a person with disability overcome the Psychological impact of disability rise from state of dependency to independence and become a self-confident, self-reliant and contributing members of the society to which he/she belongs (Aiyeleso, Onajo & Kadala, 2020).
5. Typologies of Rehabilitation Services
5.1 Medical Rehabilitation
Medical rehabilitation is concerned with improving functioning through the diagnosis and treatment of health conditions, reducing impairments, and preventing or treating complications. Doctors with specific expertise in medical rehabilitation are referred to as physiatrists, rehabilitation doctors, or physical and rehabilitation specialists. Medical specialists such as psychiatrists, paediatricians, geriatricians, ophthalmologists, neurosurgeons, and orthopaedic surgeons can be involved in medical rehabilitation, as can a broad range of therapists. In many parts of the world where specialists in medical rehabilitation are not available, services may be provided by doctors and therapists. Rehabilitation medicine has shown positive outcomes, for example, in improving joint and limb function, pain management, wound healing, and psychosocial well-being (WHO, 2011).
a- Therapy
Therapy is concerned with restoring and compensating for the loss of functioning, and preventing or slowing deterioration in functioning in every area of a person’s life. Therapists and rehabilitation workers include occupational therapists, orthotists, physiotherapists, prosthetists, psychologists, rehabilitation and technical assistants, social workers, and speech and language therapists. Therapy measures include:
training, exercises, and compensatory strategies;
education;
support and Counseling;
modifications to the environment;
provision of resources and assistive technology (WHO, 2011).
b- Audiological Service
Audiology is concerned with restoring and compensating for the loss of hearing, and preventing or slowing deterioration of hearing loss in person. Audiologists are medical specialists who are concerned with normal and abnormal aspects of hearing diagnosis and rehabilitation of the deaf and hard of hearing. This service helps to determine the range, nature and degree of that hearing loss as well as provide hearing aids, language auditory and speech reading training (Ferrans, 2008).
c- Ophthalmological Service
Ophthalmology is concerned with restoring and compensating for the loss of eye functioning, and preventing or slowing deterioration of eye-sight loss in person. The opthalmologist are medical specialists responsible for the health of the eyes. They consider the physiology of the eyes, its organic aspects, diseases and structure. They provide rehabilitation services in form of medicine or supportive aids like eye-glasses for persons with visual impairments (Ferrans, 2008).
c- Neurological Services
Neurology deals with brain injuries, brain tumors and stroke cases. The neurologists are medical specialists who evaluate the development and functioning of the central nervous system. They provide rehabilitation services to persons with spinal cord injuries (Ferrans, 2008).
The above-mentioned medical services are provided by physicians respectively who are either brought into the rehabilitation team or attend to the client in a hospital. In well organized rehabilitation programme, the cost of medical rehabilitation service is borne by the public through Medicare, healthcare insurance schemes among others. Early identification of and prevention of impairments in children may be organized as part of medical habilitation before such disorders get out of hand to constitute handicaps to life and employmen (Ferrans, 2005).
5.2 Psyco-Social Rehabilitation (PSR)
These are rehabilitation services that involve restoring the social functioning and the dignity of persons with disability, inter-personal relationship training, building self-esteem and self-concept. PSR is a treatment approach designed to help improve the lives of people with disabilities. The goal of psychosocial rehabilitation is to teach emotional, cognitive, and social skills that help those diagnosed with mental illness live and work in their communities as independently as possible (Okeke, 2001).
In addition, psycho-social rehabilitation addresses behavioral and mental health issues faced by individuals across the lifespan who are affected by any injury or chronic condition that leads to disability, including issues such as emotional coping, counseling for adjustment to disability and behavior that promotes positive adaptation to disability. Also, the parents, caregivers or family members of PWDs are served through psycho-social rehabilitation by Psychologists to adjust to a disabling status of their children with disabilities. That is, rehabilitation psychologists offer services to family members/caregivers with specific information about the particular disability, along with skills for coping with their family member’s disabling condition (Hale & Cowls, 2009).
5.3 Educational Rehabilitation
Educational rehabilitation programmes in this context will refer to acquisition of pre-requisite body of knowledge and skills for independent living. It is a mere acquisition of basic literacy and skills as well as educative training in some prescribed areas of learning which enables persons with disabilities to participate in their society and contribute their quota for national development. Educational rehabilitation programmes for PWDs start from elementary schools to tertiary institutions. The educational rehabilitation programme is designed towards attainment or meeting the unique needs of persons with disabilities in terms of education. Such programme is meant to address their unique needs for proper placement and the attainment of ultimate goal of being independent members that can contribute to societal development in all segments of life endeavor (Tuggar, 2016).
Furthermore, educational rehabilitation entails a range of services including social work services and rehabilitative counseling, provided to individuals with disabilities. Educational rehabilitation services are provided by teachers with professional certificates. Some teachers specialize in working with children and adults with visual impairment, hearing impairment, physical and health impairment, intellectual disabilities, or multiple handicaps and so on. To qualify for educational rehabilitation, a child or an adult must be diagnosed as having a disability and the disability must be found to adversely affect educational pursuit or activities (Mogbo, 2002) cited in (Azanr, Isola & Aiobiewe, 2015).
5.4 Vocational Rehabilitation
Vocational rehabilitation is a multi-disciplinary approach that involves a team effort of professionals in different disciplines who contribute their expertise to improve the well-being of the persons with disabilities so that they can be physically, psychologically, socially and culturally ready and competent to seek a job and to maintain a job (Crawford, 2006). Also, vocational rehabilitation has to do with the training on the job seeking skills like employability training offer for PWDs by NGOs and other civil societies in the community (Wright, 2006).
According to Onuzurike (2001), vocational training is activities which essentially aim at providing the knowledge and required skills for employment in a particular occupation or group of related occupations in any field of economic activity. There are various vocational skills that PWDs can be engaged in; they can be empowered in various trades that will enable them to contribute their quota to the society in which they live. Persons with disabilities can be trained in various vocational skills like pottery, carpentry, poultry, fishery, tailoring, leather work, tie and dye, soap making, shoe making, mechanics, home economics, and so on.
6. The Need for Sustainable Rehabilitation of Persons with Disabilities
The need for sustainable rehabilitation of PWDs can never be over stressed. This is because effective rehabilitation programmes focus on helping the persons with disabilities not only to adjust well but also to become gainfully employed. Okeke (2001) opined that the major justification for rehabilitation is the demand for social justice which no democratic society can deny. Every person, regardless of his/her conditions has worth, dignity and respect. Therefore, PWDs have inalienable rights to rehabilitation to enable them contribute their quota to the national development. Thus, the following reasons necessitate the need for sustainable rehabilitation programme for persons with disabilities:
6.1 Sustainable Rehabilitation Lead to Cost Reduction Benefits and Reduces Dependency Effects
As noted by Garuba (1996) cited in Aiyeleso, Onoja & Kadala (2020), the economic function of special education which includes rehabilitation can be considered from two sides of cost reduction benefits and reduced dependency effects. In this case, the training provided for PWDs reduces the cost of maintaining them in a home or institution setting. Since such persons are now trained and equipped with skills, they can maintain at least some minimal level of self-sufficiency and economic participation. This further reduces their dependency on the society and family for the provision of some of their needs. Thus, from being a consumer only, a trained person with disability becomes a producer and contributor to the economy. The second way of looking at the economic impact of sustainable rehabilitation is to consider its contributions towards increasing the quality and quantity of the nation’s resources – human and materials. Fully rehabilitated and employed PWDs will pay taxes. Those who are self-employed, in addition to paying taxes, also add to the volume of Gross Domestic Product (GDP). Through sustainable rehabilitation, the untapped potentials of the PWDs are fully harnessed for the utmost benefit of the society thereby increasing the quality and quantity of manpower supply for national development.
6.2 Sustainable Rehabilitation Is A Viable Means of Equalizing Developmental Opportunities for PWDs
In the case of Nigeria, the National Development Plan, National Policy on Education emphasizes equal opportunities for all Nigerian citizens in education, including acquisition of skills for self-employment. As Nigerian citizens, PWDs have rights to any form of education and vocational training that will enable them attain self-actualization in the interest of national development (Jackson, 2009). As Okeke (2001) rightly noted, the principle of equality of educational opportunities for all citizens imposes an unavoidable services for PWDs to enhance their physical and vocational preparedness for gainful employment and participation in the privileges and responsibilities of Nigerians as full citizens.
6.3 Sustainable Rehabilitation Is Human Capital Development
The potentially important role of PWDs in a nation’s development cannot be overemphasized. PWDs could be the source of labor inputs as well as human capital in production, which would improve the total factor of productivity in a state of the federation where capital formation is limited. When rehabilitated and employed, PWDs could be a reliable source of demand for the economy through their productive activities. In addition, the PWDs could be useful for the national development of any country if properly rehabilitated and harnessed. Furthermore, every country has an opportunity to harness a “demographic data of PWDs for utilization and national development” (Ferrans, 2008).
7. Conclusion
The provision of sustainable rehabilitation programmes for PWDs are integrated into the ordinary process of serving every other citizen or they can be excised out of the ordinary process and channel through specialized agencies of the government or non-governmental organizations. The guiding principles for a sustainable rehabilitation programme is that PWDs shall as far as possible be equated with other groups, and have access to the same resources. This effort towards integration means that rehabilitation is incorporated in the public sector’s regular activities such as medical care, social care, education and vocational training. Meanwhile, It is very important to note that no rehabilitation process is complete until the trained PWD is physically independent, economically self-reliant and/or gainfully employed in chosen career or job.
8. Recommendations
For rehabilitation programme to be sustainable, the following recommendations should be taken into cognizance:
Assessment is an educational, mental, social and psychological diagnosis done mainly for appropriate placement to a programme. Therefore, before a person with disability can be placed on an appropriate rehabilitation programme, he/she should undergo a comprehensive assessment. From the assessment, we will know the right intervention programme for sustainable rehabilitation.
Support services/facilities are specialized services/facilities that help persons with disabilities to function effectively in his/her environment. Therefore, the issue of providing support services/facilities for PWDs should be addressed with all seriousness for sustainable rehabilitation. Without these essential support services/facilities, sustainability of rehabilitation programme for PWDs will be a mirage.
Monitoring/supervision is the follow up and inspection of the programme during and after completed. Therefore, monitoring/supervision is necessary to assist the successfully rehabilitated persons with disabilities to gain and maintain proper adjustment on the vocational skills and/or the job.
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