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Integrated National Disability Strategy

White Paper
Office of the President

Social Welfare and Community Development

INTRODUCTION

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.

POLICY OBJECTIVES

The following policy objectives relate to social welfare and community development. The need to:

  1. develop social welfare services that aim to integrate people with disabilities within all activities in their communities;

  2. develop social welfare services which recognise the differing specific needs of people with disabilities as one component of a range of disability-related services;

  3. facilitate the reorientation and training of social welfare workers. This should include the training of people with disabilities as service providers in order to provide for more disability sensitive and integrated community development processes.
COMPONENTS

Components that need to be involved in social welfare delivery include:

Community Development

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:

  1. The support for and strengthening of disabled people organisations.

  2. 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:

  1. 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.

  2. 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: This places disabled residents in an extremely weak and vulnerable position, with little recourse to change.

  3. 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.

  4. 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.

MECHANISMS

Mechanisms that should be involved in meeting policy objectives include:

NGO Sectoral Involvement

Disability specific organisations that provide a wide range of services to people with disabilities have developed, with part-subsidisation from the state, over many years. The majority of these organisations are affiliated to, or programmes of, the five national welfare councils.

Most of these organisations are run by non-disabled service-providers although, through a democratisation process in recent years, people with disabilities are now represented in the management of welfare organisations.

Organisations of disabled people have also mushroomed since 1984. The majority are affiliated to Disabled People South Africa (DPSA). Decision-making and control lies with disabled people themselves.

Although the main focus in DPOs is on community development, a number of these organisations have initiated services, albeit without any government support.(Footnote 55)

The shift towards regarding disability as a predominantly human rights and development issue requires a review of subsidisation criteria. In this regard, there must be a particular focus on the recognition, strengthening and support of DPOs.

Public Awareness

The Department of Welfare, through its community development initiatives, is a key partner in increasing public awareness on disability as a human rights and development issue.

Another component of public awareness is the availability of information on social welfare services in a format accessible to all people with disabilities.

Personnel Training

It is essential that social welfare service-providers are equipped with the skills and attitudes necessary to provide services in an appropriate and accountable manner.

This involves the development of training programmes to re-train existing personnel, as well as new programmes to raise awareness and develop appropriate attitudes. Service providers must also be trained to understand the paradigm shift (to the Social Model) in social welfare and, most important, in disability.

Inter-Sectoral Collaboration

The development of effective welfare services and inclusive community development strategies which enhance independence and create equal opportunities can only be achieved if the strategies are pursued in collaboration with other line function ministries. The Department of Welfare has played a vital role in fostering inter-sectoral collaboration at national level by providing funding for the National Co-ordinating Committee on Disability (NCCD).

Monitoring and Evaluation

Mechanisms to ensure effective monitoring and evaluation of the impact and integration of services should be built into all welfare programmes. The active participation of consumers of these programmes will depend on the provision of resources and opportunities to contribute to policy development, planning and monitoring.


Social Security

INTRODUCTION

The present social security legislative framework, its administration and allocation systems; tend to be discriminatory, punitive, insensitive to the specific needs of people with disabilities, uncoordinated, inadequate and riddled with high levels of fraud.

An equitable and just social security system that aims to meet the basic needs of people with disabilities unable to support and maintain themselves, should include:

  1. appropriate assessment mechanisms;

  2. accessible information and pay-out facilities;

  3. appropriately trained officials and administrative staff;

  4. effective feedback mechanisms, and

  5. a co-ordinated social security safety net.
POLICY OBJECTIVES
  1. To provide for a co-ordinated and equitable system of social security to meet basic needs and to develop capacity for independent living, self-sufficiency and integration of people with disabilities into the mainstream of society.

  2. To increase the supply of accessible information to consumers on how to access benefits, criteria for qualification and the availability of mechanisms to assist with problems which may arise.
COMPONENTS

State Grants and Pensions

Disability related state grants or pensions are:

  1. Disability grants for people over the age of 18 years.

  2. Special care grants for children with severe physical (including sensory) and/or mental disabilities between the ages of 1 and 18 years.
The majority of people with disabilities living in South Africa depend on social welfare grants for their survival. This places a large burden on the social security system. Yet a break down of the 1994/5 disability grant allocations according to race indicates that the number of black disabled people receiving grants is far less than the actual number of people with disabilities qualifying for social assistance.

In addition, the present maximum allowance for a disability grant falls far short of the Household Subsistence Level calculated by the Institute for Planning Research (UPE) in 1992. This means that the income of many disabled people and their families falls far below the estimated subsistence level. This further emphasises the need to link social security benefits with income generation strategies.

Problems that people with disabilities experience in connection with the administration of grants include:

  1. Assessment criteria and procedures: the decision usually lies with a single medical doctor, often ill-informed about the relationship between disability and employment.

    Applicants who are turned down do not have access to reasons for their unsuccessful application and no effective and accessible appeal mechanism exists.

    Definitions of disability vary and create confusion.

  2. Means test and other benefits: recipients of social security grants lose all free housing and social benefits once they have additional income, even if this still falls below the household subsistence level. This discourages people from seeking employment for vocational training.

  3. Physical facilities: pension pay-out points are often based in unsympathetic environments, especially in rural and disadvantaged areas. Factors such as lack of shelter, inaccessible buildings, unsafe environments, long queues add to a sense of dehumanisation and disempowerment.
Workmen's Compensation

The Workmen's Compensation Fund compensates workers who are disabled by accidents which happen at work. The benefits they receive seldom meet their basic needs and usually do not compensate them for the loss of employment and poor future employment prospects.

Approval of funds for disability related costs (Footnote 56) tends to be inconsistent and often reliant on the goodwill of officials.

Road Accident Fund (RAF)

The MMF provides compensation to people who are disabled by car accidents. The complicated processing procedures often result in the suffering or even death of the disabled applicant whilst waiting for the finalisation of the claim. People in rural areas, particularly, very seldom have access to legal assistance.

MECHANISMS

Inter-Sectoral Collaboration

Effective and inclusive ways of facilitating inter-sectoral collaboration between the various departments that administer social security legislation should be developed. This is required to create a safety security net.

Personnel Training

The training of personnel involved in the administration of social security benefits should include:



Housing

INTRODUCTION

The majority of people with disabilities survive on a disability grant and have very little hope of accessing independent housing. Existing dwellings/housing and environments are often inaccessible due to poor design, infrastructure and overcrowding. This often forces people with disabilities into institutions against their wishes.

Housing schemes very seldom make provision for barrier-free design which excludes people with disabilities from obtaining housing or visiting relatives and friends.

The responsibility for capital expenditure for institutional and residential housing has, in the past, rested predominantly on the NGO and private sector.

POLICY OBJECTIVES

To provide people with disabilities and their families with safe shelter and dwellings of their own through equitable access to a range of options in the housing subsidy scheme.

COMPONENTS

Institutional Housing

A number of people with severe disabilities presently reside in large institutions run by either subsidised welfare organisations, the private sector or the state. While these places often provide shelter and necessary care to people who would otherwise have struggled to have their needs met, there are a number of important problems associated with them.

Residential Facilities

Residential facilities provide group homes in residential areas for small groups of 6-15 people, or farm-type communities for about 24-36 people near small towns or cities.

These group homes or farm communities function as part of the larger community and contribute in various ways towards the community by offering employment or providing services to local people.(Footnote 57)

Home Ownership

Like non-disabled people, disabled people with families also wish to own their own homes. They have the same needs for privacy and dignity. Yet the fact that the majority of disabled people survive on a social grant disqualifies them from financial assistance through the banking institutions.

Similarly, people with disabilities often have additional housing needs that add to cost.(Footnote 58)


Sport and Recreation

INTRODUCTION

People with disabilities experience the same need for sport, including competitive sport, and recreation as their non-disabled peers.

Sport is generally regarded as one of the vital components in the integration of people with disabilities into society. It is also often a vital component in the successful rehabilitation of people with disabilities.

Sport at school level is critical for the development of physical qualities, as well as for the development of self-esteem, courage and endurance. It is therefore vital that sport at school levelăboth within ordinary and special schoolsăreceives urgent attention.

POLICY OBJECTIVES

The policy objective is to develop and extend sporting activities for people with disabilities in both mainstream and special facilities so that they can participate in sport for both recreational and competitive purposes.

MECHANISMS

Training of Trainers

The development of trainers/coaches familiar with sport for disabled people is an essential component which needs to be urgently addressed. This process should involve both familiarising existing coaches and trainers with aspects relevant to the coaching of disabled athletes, as well as the training of trainers specialising in sport for disabled athletes.

Physical Facilities

Existing public sport facilities tend to be largely inaccessible. This includes changing rooms, lockers, showers, toilets and so on.

Community sport centres should be developed in consultation with organisations of disabled people to ensure not only barrier-free access, but also integrated universal design to allow both non- disabled and disabled athletes to use the facilities simultaneously.

Public Education

The public-at-large, people with disabilities (especially those living in rural areas), sponsors and sport administrators tend to be largely unaware of the different forms of sport for disabled people. This aspect should be targeted in a public education programme.

Sponsorship

Sport for disabled people should be 'mainstreamed' as far as possible to increase sponsorship value. In other words, it should be promoted jointly with mainstream events.

Co-ordination

There are two major umbrella bodies for sport for disabled people in South Africa: the National Paralympic Committee of South Africa (NAPCOSA) (physical and sensory disabilities); and the Special Olympics South Africa (intellectual disabilities).


CHAPTER THREE: NOTES

(1) The prevention of sports injuries is an example.

(2) As in otitis media, and sight restoring interventions, e.g. cataract surgery.

(3) For example, contracture.

(4) In literature, for example, disability is often linked to concepts of cruelty, ridicule and helplessness.

(5) Thus, as regards disability, one may move from a position of total ignorance to preliminary awareness of disability within the community and, from there, to an attitude of concern. This concern may, however, be expressed within a paternalistic and patronising framework (the Medical Model). The next transitional stage may be the development of a sense of justice, of seeing people with disabilities as citizens with equal rights (the Social Model).

(6) e.g. Human Rights Day (21/03), Freedom Day (27/04), Worker's Day (01/05), Youth Day (16/06), National Women's Day (09/08), and Day of Reconciliation (16/12).

(7) As in the reproductive health services.

(8) Personnel and other rehabilitation workers include, amongst others: therapists and community rehabilitation facilitators/workers, orthotists and prosthetic surgeons, psychologists and psychiatrists, social workers, parents and disabled people themselves, medical doctors and nursing personnel, educationists, career guidance counsellors, community members, community development workers, engineers.

(9) For example, through day care centres, vocational training centres and so on.

(10) DPOs and parent organisations are typically engaged in some of the following rehabilitation activities through the establishment of day care centres, vocational workshops and advocacy projects: identification of people with disabilities; basic assessment of people with disabilities (especially children); referral of people with disabilities to the relevant resources; health promotion and prevention; information dissemination; social rehabilitation (peer counselling and support groups); assisting with maintenance of assistive devices; encouraging participation in community activities (integration); vocational training of persons with disabilities, and Sign Language and interpreter training.

(11) For example, hospitals and clinics, schools and vocational centres, institutions (e.g. residential centres for intellectually disabled children and adults) and at home.

(12) It includes, amongst other things: screening, early identification and intervention services (e.g. at-risk babies), splinting limbs to prevent contracture (e.g. burns), swallowing therapy (e.g. after a stroke), muscle strengthening and retraining (e.g. after partial paralysis of a limb), learning how to use an assistive device (e.g. transferring from a wheelchair, using a hearing-aid, etc.) bowel and bladder rehabilitation.

(13) Such as the reconstruction of thought processes, improving concentration and memory, improving co-ordination, improving interpersonal relationship skills.

(14) It includes: identification of learners with special education needs (screening and assessment); individual therapy at special schools; support programmes and advice for teachers in regular centres of learning, vocational training and career guidance; provision of specialised equipment and appropriate technology within centres of learning that will enable learners with disabilities to access the system.

(15) Vocational rehabilitation services include, amongst other things: vocational training, placement in the open labour market or sheltered employment, vocational guidance services, adaptations to the workplace, including the provision of specialised equipment and devices.

(16) It includes amongst other things: training in self care activities, including mobility, communication and daily living skills (e.g. using ATMs at banks); adaptations in the home; sexuality counselling (relationship and sexual counselling, family planning); peer counselling.

(17) Including wheelchairs, crutches, prostheses, walking frames, white canes, guide dogs, special seating support, audible traffic signals.

(18) These include Braille frames and machines, adapted computers, magnifying glasses, hearing aids, Sign Language interpreters, TTY's alternative and augmentative communications systems, information technology, cleft palate plates, etc.

(19) Liquid level indicators, kettle tippers, adapted handles etc.

(20) Commercial suppliers of specialised equipment; commercial suppliers of regular products (e.g. hand free telephones); provincial hospitals; organisations/individuals making one-off modifications or devices; NGOs making devices available on temporary loan and co-ordinating the redistribution of devices through banks (e.g. spectacles, hearing aids etc.); organisations making available information and advice on appropriate devices.

(21) For example, flights of stairs, inaccessible toilets and bathrooms, high kerbstones, uneven pavements.

(22) For example, bank/shop counters, public telephones, ATMs.

(23) For example, turnstiles, microphone-loudspeaker systems etc.

(24) For example, schools, clinics positioned at the highest points in town, narrow pavement areas, lack of demarcated special parking bays.

(25) For example, fixed seats in restaurants, clustered rooms.

(26) Promulgated in 1986.

(27) For example, public works (public buildings, legislation and policy), health (clinics and hospitals), education (schools, universities, technikons, colleges), tourism and environmental affairs (hotels, environmental centres and tourist attractions), local government (town planning and approval of building plans) and so on.

(28) Key issues that need to be addressed in order to optimise the use of taxis for disabled users include: service quality, the retrofitting of a select number of vehicles to make them accessible, insurance, driver training and financial viability.

(29) These include, for example, the painting of bright yellow strips on bus steps to aid people with low vision; installing more grab bars/poles on buses for elderly/frail people to hold on to; providing sensitivity training to drivers to assist in the transport of disabled users (such as calling out stops for people with visual disabilities); welding on an adjustable first step to lower the step height; reserving seats for elderly and disabled users.

(30) Be they schools, hospitals, transport systems, police stations, emergency services, universities or the electoral process.

(31) For example, the use of Sign Language and sub-titles on television, availability of documents in Braille and/or on cassette, availability of communication boards for non-speaking people, assistive listening devices and systems for Deaf people (such as TTYs, closed caption decoders).

(32) Existing data bases include, amongst others, Health Information Systems, including RHEMIS; Genetic Services; Specialised Schools and Institutions, as well as the EMIS system; Department of Labour (unemployed disabled job-seekers); NGO Directories (e.g. PRODDER, Bridge, SANGONET etc.); child reference and information centres in metropolitan areas; disability NGO service providers (e.g. Bureau for Prevention of Blindness).

(33) For example, job advertisements, community based multi-purpose centres, and so on.

(34) The TTESS has been renamed the National Committee for Educational Support Services or NCESS.

(35) Early Childhood Development (ECD); General Education (GE); Further Education (FE); Higher Education (HE); Adult Basic Education and Training (ABET); Education Support Services (ESS).

(36) For example, teachers, therapists, psychologists, houseparents, parents and disabled activists.

(37) Through, for example, Sign Language, Braille instruction and adapted learning materials.

(38) In the case of Deaf learners, the Deaf community argues that this means a signing environment with free access to Sign Language and Deaf culture. There is therefore a need for special education for Deaf learners, catering for their unique language needs with Deaf adult role models, Deaf peers, a signing environment, teachers fluent in Sign Language and free access to Deaf culture in school and residential facilities. The Deaf community views the full integration of a Deaf child into a hearing classroom, even with the help of an interpreter, as restrictive to the child.

(39) For example, appropriate technology, interpreter services/Sign Language instruction for Deaf learners.

(40) For example, flexible curricula, respect and understanding for diversity and human rights, equipped teachers, barrier- free environment.

(41) The Deaf community argues for a special focus on the Deaf child from the age of 0-3 born of hearing parents.

(42) The Deaf community argues that, in the case of Deaf children, ECD and stimulation should include Sign Language instruction and the training of parents in Sign Language to enhance parent-child communication, relationships and education.

(43) The Deaf Community argues that, in most cases, compulsory education for children with disabilities should start at the age of 3 or 4 years to compensate for delays in language, cognitive, physical, emotional and social development.

(44) The Deaf community argues that the rights of Deaf learners should also be protected. The parents' rights and preferences should not be allowed to violate the Deaf learner's basic human right of free access to his/her language and culture.

(45) For example: adults with communication disabilities experience particular difficulties in accessing regular ABET programmes due to the failure to meet language needs of the Deaf and others with special communication needs; adults with disabilities residing in institutions, or undergoing long periods of hospitalisation have no access to ABET; adults with disabilities who have attended special schools up to primary level in the past do not have access to further education through adult bridging courses.

(46) This support includes, amongst other things: all education-related health services, assessment and placement services; social work; vocational and general guidance and counselling, and other psychological programmes and services.

(47) For example, punitive health requirements.

(48) For example, unemployment insurance, pension scheme membership, health insurance.

(49) For example, part-time work, flexi-hours, job-sharing and tele-work.

(50) For example, Deaf people and people with visual disabilities.

(51) The Green Paper on a Skills Development Strategy for Economic and Employment Growth in South Africa describes a 'learnership' as, 'a mechanism to facilitate the linkage between structured learning and work experience in order to obtain a registered qualification which signifies work readiness'.

(52) I.e. not market related and not in line with NQF standards.

(53) This could also include advanced independence training, such as for people with visual disabilities, or Sign Language training for supervisors of Deaf workers.

(54) For example, problem-solving, planning, informal research, budgeting, vocational skills, business skills, basic literacy, monitoring skills etc.

(55) For example, peer counselling, independence/life skills training, personal assistance, residential care services.

(56) For example, assistive devices, alterations needed at home, family counselling, etc.

(57) For example, food production or tuckshops.

(58) For example, more space to move around inside the home, with accessible entrances and pathways for wheelchair users; additional rooms for care-givers and personal assistants for people with severe physical or intellectual disabilities; additional or adapted security systems for people with sensory disabilities.

National Disability Strategy Contents