The fundamentally differing institutional approach needed for CBR

Chapter 6Conclusion and Recommendation

The lack of available information in the organisation regarding the actual prevalence of children from each type of disability should be address through further research. This lacking has made unclear the justification for providing IBR or OR services to children with specific type of impairment.

The problematic relationship between community and children or person with disabilities and the nature of ‘provide and receive relationship’ between the organisation and their ‘clients’ has the down side effect with the danger of IBR organisation becoming a ‘dumping site’ for un-accepted members of communities, the issue of power balance and the fostering and re-creation of the ‘other’-ing identity for persons with disabilities and the furthering of social exclusion.

The consideration to look into IBR strategy critically and the need to look into it more justifiably is necessary because this strategy has important role in some specific case. Children who are severely impaired and need immediate institutional care and continuous assistance to live are amongst those whom physiologically need to have IBR intervention to physically survive. Also, children who physiologically are not at life threatening risk but whose social environment is 'impossible' and need IBR including those who have lost any social support from immediate family members, i.e. in the case of orphans.

Another alternative approach is through a combined strategy where IBR services playing the role in providing the specialized type of intervention such as surgery and other medical intervention and the post-surgical therapy to be done in the community. This can be another potential right justification for IBR intervention. The objective non-bias aspect of IBR support lies in the clarity of such considering factor of justification and the time frame of support in which clear exit strategy aiming at best possible way to facilitate the integration of the children post-IBR intervention.

The economic factors as additional contributing factors in how the child came to be the recipient of IBR services as described in most of the case stories has to be addressed. This justification is another down side of IBR services, whom services should remain as specialised intervention for specific cases. It is recommended therefore to separate the specialised intervention of IBR institution to the on-going poverty reduction strategy, which should continue and remain as part of community development strategy.

In term of OR support, the mentioning of the economic factor has a different dimension as OR institution has different role and different level of specialised intervention.

As elaborated in this research paper, the justification of OR support, is in the potentiality of this services to make significant shift in terms of integration and inclusion. The shift from IBR relationship model to OR relationship model facilitate the integration of children with disabilities in their own community to a certain extent. This integration may be a catalyst for the development of the inclusive CBR oriented community.

Children with less severity of impairment who physiologically are not at life threatening risk and whose family environment is feasible for OR, but face rejection from other members of community can benefit from OR intervention. However, as described in the research paper, this put major challenge to the realisation of inclusion because it can be very challenging for CBR to work on deconstructing the value, belief and practice system in the community.

Another group of children who can benefit from OR support is those with less severity of impairment who physiologically are not at life threatening risk and have a conducive social environment. The issue of scarce resources and the capability of the organisations in doing OR as the major constrains to provide support to this group of children can be addressed with the current development of ‘mainstreaming’ strategy where non-disability sector partners are called to take part and engage in works related to providing rehabilitation support in community. The integration offer through OR will be supported by the social environment in which effort to improve mainstream services will allow possibility for the creation of inclusive community.

Finally, although this research paper did not gain data on CBR support, from conceptual exploration and reflection on the pattern in IBR and OR services, it is possible to conclude that this strategy work best for empowering children or persons with disabilities who physiologically are quite capable of greater social interaction, but socially discriminated against. In this situation, there is very little need for OR. Those who fit into this last category include children or persons with disabilities who are of mild mobility impairment and those who became disabled from illness or accident. This group of children or persons with disabilities can remain as active member in the community and will be able to challenge the value, belief and practice system from within the community. The CBR work will be to enhance their capability to actively participate in the community.

This research paper provides important insight to the different reality for the existence of the three rehabilitation strategies. The constraints in supply side capacity and attitudes of the organisations providing the rehabilitation services can potentially delimit who will be identified to receive the services and what will be provided. More ethnographic qualitative research is therefore needed to find out more about the needs of children with disabilities. This research is to be supported with quantitative research on the prevalence of disability in the area and research on available local resources and the level of acceptance of community towards persons with different type of impairment. The availability data and ethnographic information can enable the review of the on-going practise to identify area for improvement and development.