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Community Based Rehabilitation and Inclusive Development

Strategic Objective

CBR is a WHO-Primary Health Care initiative designed to promote inclusive development for Persons with Disabilities, by providing adequate access to Quality Health and Rehabilitation, Education, Social and Empowerment opportunities, which guarantee their full and active participation in the society .The CBR Matrix aims to prevent disability situations, manage identified disabilities, increase participation of PWDs and empower PWDs to become full and active members of the society.

The program carries out comprehensive community based rehabilitation, care, and support services within the three districts of National Capital District and 3 other provinces in order to ensure maximum impact and participation of persons with disabilities in the wider rural regions of PNG.

The program promotes, within the regions of coverage, a twin track approach of:

  1. Providing access to comprehensive rehabilitation
  2. Access to human rights, and
  3. Active participation in all development initiatives by persons with disabilities for an inclusive community development.

The program undertakes early identification of disability situations and provide appropriate intervention. Basic rehabilitation skills training and capacity building on disability care and human rights are disseminated to the community and families in the households or as organized groups during family visits and Focused Group Discussions. Use of local resources is promoted through strengthened coordination with local support networks, improvisations of suitable assistive aids and volunteerism. Over 600 children and 1000 families are currently in the program across the National Capital District. While over 5,000 have benefited in the past through medical referrals and disability awareness aimed at averting preventable disabilities.

Economic skills training and development through participatory approaches is provided to organized groups to enhance individual household incomes for self-independence in livelihoods support.

The programme, through partnership with other stakeholders, promotes awareness and increased access to information, education and communication materials on HIV/Aids and gender development to PWDs and their families. As cross-cutting issues affecting PWDs or/and their families.

Community based networks are identified and strengthened while utilization of local available resources are promoted through participatory processes to reduce the cost of operations and enhance sustainability.

Physiotherapy Referral and outreach services

Strategic Objective

The Physiotherapy Referral and Outreach Program provides assessment, training and rehabilitation services for persons with disabilities or debilitating medical conditions who come from non-CBR catchment areas. It supports those who have been referred or discharged from the surrounding health facilities who require progressive rehabilitation services outside of the hospitals. It takes care of people with acquired physical injuries, and or health conditions which may cause restrictions in individual physical performance levels. In-house Training and Capacity Development for CBR Field workers, Carers and Parents are critical services provided by the program which is located within Cheshire. The program, an arm of CBR, combines a range of treatment modalities which include physical exercises, training and electrotherapy-administration of heat, cold and electric current modalities to manage a wide range of physical health conditions.

The physiotherapy services are provided to the residential care service users, inclusive education children, and children with all forms of disabilities identified from or referred from the wider NCD and the Central Province. The programme undertakes physical assessment of the referred children and adults to outline rehabilitation needs and treatment required. The program receives referrals and works in collaboration with POMGH, NBDP, National Orthotics and prosthetics (NOPS) St. Johns, Red Cross, Department of Education, and DfCD among others. The organization has qualified physiotherapists who are supporting the implementation of the services on a daily basis. Over 80 children from NCD are being supported through the program.

The Geographical situation in PNG makes it difficult for free and reliable transport and communication in accessing rehabilitation facilities. Many PWDs are therefore unable to access services due to their locations and the difficulty involved in transport means and movement. While disability is closely associated with poverty, many more PWDs are expected to be in the rural homes or provinces where much infiltration of disability information and services is still poor

Cheshire undertakes a centre based physiotherapy services for ‘out-patient’ services and outreach mobile clinics to the peri-urban, with hope for futureexpansion into the provinces.The organization works closely with location based clinics and institutions to reach out to PWDs and provide home based training in disability care and support. The community based health care partners receive adequate training on early identification for immediate intervention and prevention of avoidable disabilities.

provision of quality inlcusive early childhood care education and inclusive education services

Strategic Objective

Education is the second CBR matrix after health. The program aims to prepare and afford accessible opportunities for children with disabilities to learn with normal children in the same classrooms within mainstream school settings from Early Child Care Education (ECCE) level, through to higher levels. It aims to equip the parents and care givers with positive parental skills. To provide mainstream teachers with techniques and skills to support the learning needs of children with and without disabilities. It creates opportunities for mainstream school children to appreciate the uniqueness and embrace children with disabilities in their midst. To accept, accommodate and support them in their midst. It seeks to ensure that the school environment is barrier free, safe and conducive for learning to all children in order to maximise their social and academic participation throughout their school life.

The school is run in collaboration with the department of education, who provide teachers for the centre based class. School board consisting of parents, education department representatives, community is in place to oversee the management and operation of the school. The school consist of centre based class for children with disabilities and early childhood intervention class for children without disabilities. The children are below 6 years and must either be from the neighbouring community or brothers and sisters of those in the centre based class. The unit is meant to promote mainstreaming and integrated learning and as a contribution to the neighbourhood.

The school works with the local regular schools to provide induction training to the mainstream school teachers for inclusive enrolment of children with disabilities from our centre based to the regular schools. Education is a major priority area for the government of PNG and the complementing development partners. Children with disabilities equally need inclusion into the mainstream schools. Though there is education resource centre currently being supported by Department of Education and Cheshire, there are few special teachers, making student teacher ratio to be untenable. The current ratio is one teacher to 16 children with special needs (CWSNs) which is not compatible with the UN requirement of 1 teacher to 5 children with disabilities.

Cheshire aims to strengthen its partnership with the Education department and other development partners to provide quality education through posting of more teachers and increased enrolment of children, especially the girl-child into the mainstream schools. The Board of Management specifically for the school has already been established to oversee the running of the school. The board comprises representatives from teachers, parents, government departments, NGOs, and disability groups. Provision of accessible and adoptable sitting aids and teaching materials will be a priority. The board will also provide a road map for strategic fundraising to support school activities and to provide essential resources which are currently either lacking or in limited supply.

Parents and friends association is already in place to promote different activities and social action plan that will increase the abilities of the parents to sustain the ongoing school activities and to create new diversified activities with children inclusive.

respite care and protection program

Strategic Objective

Being the oldest, the program provides respite care services to fulltime residents who were rescued in the early stages of their lives after being abandoned, neglected, or abused by their families or relatives. Majority were brought in by the police, the social welfare unit of Community Development and the Catholic Mission who were managing the facility in the early 70s.

The new focus of the unit is to provide tailored training in self-care skills and mentoring of the residents so they can become full and active members of the society. Home reintegration plans for those whose families have been found, is being provided so they can re-join their families, stay with the families and exercise their full rights under the UNCRPD which PNG is a signatory to. Support for income generating activities would be sought to sustain their livelihoods while staying with their families.

Providing support for everyday living (SEL) and protection (medical/nursing care, nutrition, and shelter). Training of service users in acquiring independence on activities of everyday living, physiotherapy and vocational life skills. Promotes linkages and vocational job placements for service users under the self-care management. Capacity building to the carers for continued support and transfer of skills to the visiting families and guardians.

The residential care programme caters for full time resident clients who receive essential routine care, protection, and support services with the help of carers and other professional technical staff. The residents have varying severity of physical conditions. Over 80% are fully dependent on care and support while 20 % can partially be supported to meet their activities of everyday living.

The conditions of the residents call for balanced diet and health improvement to prevent opportunistic ailments. Considering that some clients have urine and bowel incontinences, promotion of hygiene is therefore essential in accomplishing healthy wellbeing and development.

The current 12 carers are working on day-night shifts to maintain satisfactory standards of care and support to the 20 full time residents. The major activities are undertaken to improve on activities of daily living and include:

  • Development of individual care plans for all service users.
  • Training and capacity building to the service users committee, carers and staff.
  • Provision of balanced food diet and nutrition need for healthy living.

A committee comprising of service users and carers has been instituted to manage the day to day activities of the service users and to handle various concerns and challenges affecting the users. The committee works to identify skills, talents, and potentials on the best interest determination (BID) of individual service users to be addressed. The committee also takes care of donations received and prioritize their distributions to the users.

A duty statement to this effect has been jointly developed and is currently operational. The committee is elected by members to serve for a specified period before ushering in new leadership through changing roles.

The following activities will facilitate participation of service users into Inclusive Development initiatives:

  • Vocational and self-care skills training.
  • Livelihoods and economic skills enhancement opportunities.
  • Sports and recreational engagement to improve physical health and functional mobility
  • Certification of citizenships and membership into organization of and for persons with disabilities.

Home-Reintegration— of the Residents

The organisation has also taken a new approach to reintegrate the residents back to their families. In the hope that their families will soon create time and space for their loved ones in their home. So far only about 3 or 4 families have been contacted. In year 2015, two residents have visited their families, and spent some time with them. Unfortunately, for the rest of the Residents, the organisation does not have record of the whereabouts of the families. Whilst it remains a challenge, 24-hour care and support continues.

Donations in cash or kind which are received daily, weekly and or monthly is very important especially in maintaining their diet and hygiene promotion . Hence the organisation continues to honor the great partnership it has with the business houses, private entities, government stakeholders, other charitable organisations and individuals who continue to show their support through their kind giving. Almost 70% of the donations consist of dry and canned food items. Depending on the foods’ condition most are preserved only up to 3 months, while a few are preserved longer. Most times there is limited supply in fresh vegetables and fruits. To maintain the diet, the administration tries to purchase from the local markets but again these has become costly as the produce have become too expensive. The organisation is looking for ways to address the need, it has been also discussed to till land at the back yard for gardening, hoping it gets started up and running soon. The toiletries including diapers and cleaning detergents received from donations play a very important part in their wellbeing as well.

youth development and livelihoods- young voices and women empowerment

Strategic Objective

The youth and women with disabilities, or the women who are care givers of children with disabilities are critical pillars of the development. The focus of the program is to ensure that youth with disabilities do not miss out in development opportunities, while care givers are given the necessary support to manage the daily needs of their loved ones with disabilities. The youth would be supported through mentoring, training and job placements, while the care givers who are women, besides benefiting from the same, would be supported to have viable businesses from where they would derive income to support the needs of their dependents.

Program Support and Development

Strategic Objective

Being the oldest, the program provides respite care services to fulltime residents who were rescued in the early stages of their lives after being abandoned, neglected, or abused by their families or relatives. Majority were brought in by the police, the social welfare unit of Community Development and the Catholic Mission who were managing the facility in the early 70s.

The Services We Provide (benefitted over 8,500 PWDs, and 10,000 families since 2009)

  • Health – Prevention, Promotion, Medical Care, Rehabilitation, Assistive Devices, Training
  • Education- Early Childhood Care, Elementary, Primary and Non-Formal Education
  • Support for everyday living and training on daily living skills for vulnerable, full time residents
  • Parents Support Groups: Mobilizing parents support groups, counselling, training, increasing social participation
  • Providing advocacy on human rights and increased participation for the youth in development
  • Livelihoods: Providing opportunities for self-reliance through income generation for PWDs

The Activities We Conduct

1. Health & Rehabilitation (Full time Home/Community Based)

  • Awareness: on disability for early detection and intervention. Causes, prevention and management of disabilities to communities, Government officials, leaders, partners. Door to door survey and data base
  • Health promotion: educating communities on risk factors, best health practices esp. for the highly vulnerable groups-children, women, youth, elderly
  • Medical Care: coordinating treatment for ailments/infections or conditions which may cause or resulting from disabilities. Building capacity of health officers to prevent, minimize or manage disabilities
  • Rehabilitation: providing centre-based and home based Physiotherapy and basic counselling services for PWDs and their families. Transferring skills of rehabilitation to care givers. Supporting social integration
  • Assistive Devices: providing suitable assistive devices for PWDs to increase mobility, social participation

2. Education

  • Provide awareness to communities, leaders, teachers, health workers, development partners, Government officials and school children on the rights of Children with Special Needs (CWSNs) to education.
  • Rehabilitate, assess and enroll children with special needs in schools- home based education, mainstream schools, resource centres or early childhood care centres
  • Providing training and capacity building for mainstream school teachers to manage long term educational needs for CWSNs in mainstream settings.
  • Support accessibility assessments for mainstream schools, providing recommendations for improvements.
  • Create opportunities through partners for employment or training for youth with disabilities

3. Livelihoods through Self Help Groups (SHGs) and Social Support

  • Ensures that parents & Care Givers of PWDs are socially and economically empowered for self-reliance
  • Rehabilitate, assess and enroll children with special needs in schools- home based education, mainstream schools, resource centres or early childhood care centres
  • Supporting focused Social Groups formation and training to improve best practices in business management for improved savings and further investments
  • Support accessibility assessments for mainstream schools, providing recommendations for improvements.
  • Support the establishment of strong SHGs with strong management and leadership abilities.

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