Mozambique: Evaluation of the effects of a CBR programme in changing attitudes towards people with disability
By Francisco Manuel Tembe, Maputo
Community based rehabilitation programmes, which in Mozambique are called community based support for people with disability, were established in this country in 1993, through the training of the so called Provincial coordinators of this programme. The first trainees for this came from various Institutions and/or from Organisations such as Social Welfare, Red Cross, Associations of People with Disability, Education and even from the communities. They took a nine month course divided into modules of three months each with different contents about how to deal with people with disability within communities, with strong emphasis on utilisation of existing local resources.
The program was planned and implementation initiated by the recently established Ministry of Women and Coordination of Social Action through its Provincial Directorates, nevertheless with the involvement of other sectors as mentioned above.
Trying new models
The main objective of this programme was to shift from the former model practiced in the disability area by the Social Action Ministry, and to adopt the preferred practices of maintaining the person in his/her family and in the community as well. At the same time, the aim is to try to transfer the necessary knowledge to these communities in order that people for themeselves can identify problems of this social group and try to find solutions using the existing local resources
On the other hand, the programme was established in order to change negative attitudes towards people with disability.
The long range plan is to gradually transfer management responsibility to the respective communities, so that the role of the Ministry of Women and Social Welfare can be fundamentally to "enable" or provide capacity to communities, as well as providing support and monitoring services.
The initial idea was that people with disabilities themselves would take an important role on the manangement of this programme, after receving training for this responsibility through the disability associations. Therefore, the Ministry of Women and Coordination of Social Action always tried to motivate the creation and development of the Associations of and for people with disability.
Ten years later
Now, nearly ten years later, the programme has been extended to some degree throughout the country, however with some differences in terms of strategies, methodology and developmental levels in the various Provinces and regions of Mozambique.
Introducing human rights concepts
According to the preliminary report of KEPA's (Finnish Organisation) evaluation, one result of this substantial support of disability programms in Mozambique for more than ten years, is that the community based support programme has mananged to re-conceptualize and promote the problem of disability as a human rights issue.
In this regard, many actions were undertaken within the scope of changing attitudes, and in fact, we can observe that in many regions throughout the country people changed the way and how they see and understand people with disability, and their role within their families and even communities as well.
Significant progress observed
Many children and even adults who before were hidden away in houses-- they can now enjoy life with non-disabled people. Of course, in these communities we still face a lot of taboos and different levels of understanding about how to interact with and support people with disability in cases of needs. It is a question of knowing exactly what to do in order to promote the development of this social group. At last, it seems that people within the local communities are more aware of the importance of opening full familial and community integration for people with disability, and also to enable them to achieve full and active participation in the society.
During visits to the families with children with disability is possible to see some aids and equipment developed on the basis of local resources which they (community based support workers) use for mobility training for children with difficulties in movements. In many cases, we can see they have succeded in improving the physical and mobility development of these children.
Mobilising support for school-integration
In another sphere of activity, the community based support programmes for people with disability have contributed substantially to increasing awareness of the need for pre -school and school integration of disabled children. The programmes have succeeded in identification of the children's needs, in mobilising parents to allow their children to participate in the schools, and in sensitising teachers to include children with differents types of disabilities in their schools.
Therefore, this programme has helped to firmly establish inclusive education initiatives which started about four years ago, in terms of awareness raising to the families so that they will take actions to help their children with disabilities to obtain an education.
Employment - the continuing challenge
One of the greatest challenges to this programme is that in fact it did not manage to accomplish much in solving the situation of extreme poverty which faces the majority of adults with disability. They continue to need some kind of economic integration through facilities on the employment market or through self -employment schemes.
Some still weak links
On the other hand, the programme is is aimied at the motivation of people with disability to set up their Associations, according to their interests and different categories of disabilities, in order that gradually, these Associations and other interested people can then directly become the implementers and manangers of this programme. At this moment, this is not possible because the existing Associations are still very weak, particularly at the grassroots level which means that the Ministry of Women and Social Coordination will continue to play this role for a longer time than intended.
A Provincial experience
One interesting experience of the community based support programme for people with disability has been developed in Manica, one of the Province of the Centre of Mozambique. While the majority of the Provinces develop the programme through volunteers, in Manica they decided to create local nuclei within the communities where the majority are comprised of people from Social Welfare Ministry, tecnhicians from Health, Education, community leaders and traditional healers.
The idea is a nucleus will deal with all the needs and problems in the community including ones of people with disability and of their families.
The curious aspect of this situation is the existing combination or balance in practices between modern and tradtional medicines. I could see that and had a long dialogue with a traditional healer who has a big space with many houses, where he admited about 24 persons who are mentaly ill to receive spiritual treatment towards recovery.
According to this tradional healer, in the cases where the individuals present anaemia or other illness which can only be treated at the hospital, he takes them to the hospital but in addition continues to give them spiritual treatment to reduce the mental illness.
In the case of epilepsy, the traditional healer says that he is aware that this is a chronic disease, so he only gives them medicines prepared from roots of some plants, just to reduce attacks. and counsels them not be marginalised because of this disease.
When presented with someone who has paralysis, the traditional healer says that he gives some roots and leaves of plants to the " patients", just to reduce spaciticy and to help make the body stronger.
It was interesting to note that in the community where this tradional healer lives and does his work, he is given a lot of trust and is very respected by people who say that he has been helpful to a lot to people not only from Manica Province, but also from other Provinces, especially with the treatment of mental ilness and in the prevention of secondary effects of disabilities.
Next: from darkness to light
As we can see, this community based support programme tries in fact to be a community programme and also to bring out problems within the community, nevertheless, there is a need of people with "know how" to transfer more knowledge to the local levels, so that they can work with the necessary light and not in darkness. There is a wish in the community to do a lot of things, but there is little knowledge or experience, and probably limited resources like bicycles to use to make home visits.
On the other hand, there is a need of strengthenning those nuclei and the necessity of increasing the participation of people with disability themselves and their families in running this programme. Then they will feel it is their programme and therefore that its implementation and manangement depend fundamentally on them.
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