0
Ministry of Health of the Republic of Tajikistan
National level ( Hospital
based care -Matchiton, Karabolo, etc..)
Regional (PMPC*)
District (PMPC,
CBR Support
rooms, Day
...
Main functions of the PMPCs are:
• Assessment and Diagnosis of children with disabilities:
• Early intervention / rehabili...
CBR is a strategy within general community
development for rehabilitation, equalization of
opportunities and social inclus...
H
e
a
l
t
h
E
d
u
c
a
t
i
o
n
S
o
c
i
a
l
L
i
v
e
l
i
h
o
o
d
CBR
Empowerment
• Ministry of Health, with support from UNICEF and WHO,
immediately responded to contain the virus through mass
immunizati...
• More than 800 stakeholders received basic knowledge and
training on rehabilitation and inclusion:
• Referral system thro...
 21 CBR support rooms established staffed by a mix of
nurses, doctors, social workers who had a basic training in
CBR, ch...
Gulnora was weak on her right
side after polio – there was start
of scoliosis. She was supported
to do active exercises to...
• Geographical Coverage: 3 districts
• (Rudaki, Khujand, Babajon Gafurov)
• Partnership with PMPC for:
• Cross-referral
• ...
In fall of 2012, Azizbek could not walk, he was shy.
His speech was at the level of a 2 year old and hard
to understand.
S...
• Handicap International started being
active in Khatlon region in January 2010
• Provided technical support in
strengthen...
• CBR project in Ghonchi
district, with the support
of EU and Caritas
Germany
• 20 rehabilitation workers
trained
• 28-day...
• Decrease in dependency by all 130
PWD, from all age groups, who
participated in program from 2010-
2012
• None of the pa...
At the age of 5, Burkhon could not sit
or move, or eat independently.
He was constantly taken care of by his
mother, who w...
• Cost-effectiveness;
• Maximize resources of government and (I) NGOs
• Cover both urban and rural areas;
• Family and com...
National
level
Regional
level
District level
Community level
• Institutionalization
• Professionalization
• Sustainability
• Collaboration mechanisms initiated, to be
further develope...
An inter ministrial working group on CWD has been established with
decree of the Commission on Child Rights.
• It can be s...
CBR has been implemented by INGOs since
2005, but
For Tajikistan, 10 years after being certified
as polio free , the trage...
• UNICEF
• WHO
• USAID
• Operation Mercy
• Handicap International
• Caritas Germany
• Mercy Corps
Operation Mercy (Khujand, Babajon Gafurov, Rudaki), Handicap
International Khatlon Region, EU CARITAS (Vahdat, Gonchi,
Kon...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of ...
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Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan

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Implementation of Community Based Rehabilitation (CBR) for Children with Disabilities in Tajikistan, lessons learned and steps forward
From 4th Child Protection Forum in Tajikistan, 2013.

Published in: Health & Medicine
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  • In Tajikistan the definition of disability is still based on a medical model, despite the on going efforts to change it to a social model. Even though there is an Extensive Primary Health Care network, and there is more emphasis on the hospital, or centre based tertiary level services for children with disabilities such as those at the national level. Specialised rehabilitation personal exist only at the national, hospital / or centre level. There is limited access to appropriate services for children with disabilities especially those living in rural and mountainous areas.According to a research by Caritas Germany in one district, almost all under-5 year old CWD found through village-by-village surveys already had medical consultation on disability. Some, mainly those with apparent physical disabilities, had also received `treatments ` (most often: massage). None of the families of the identified CWD had received guidance on how to provide on going rehabiliation or abilitation for their children. This data suggests, that there is an urgent need to provide information to families and communities in order to improve early identification of disabilities. In this context there is a need to have a system of reaching out more effectively and widely to these hard to reach children through low cost effective methods. And CBR can be a response to that. Because,there are enough interested people in every jamoats or villages who can be trained to work with families, according to their individual needs. With propoer training and support, they can:Support families and individuals to engage in skills training and abilitation Promote inclusion in the communicites, and assist CWD to access local basic services
  • The first PMPC was opened at the end of 2006 with UNICEF support. Now there are 9 such centres replacing the former Medical Pedagogical Commissions; As of 2012, by a decree of the Ministry of Health they are funded by the local budget.Main functions of the PMPCs are:Assessment and Diagnosis of children with disabilities:Early intervention / rehabilitation: Specialists of the PMPC provide rehabilitation for children with disabilities. Special training and support is also provided to family members for them to better support their children at home; Gate-keeping: The PMPCs have the authority to refer/recommend various options for the children with disabilities. They can refer as appropriate to an upper level in the pyramid to community based care. Their mainly aim is inclusion as much as possible.
  • According to the 2003 Joint UN Statement Community based rehabilitationis a strategy within general community development for rehabilitation, equalization of opportunities and social inclusion of all children and adults with disabilities.CBR is implemented through the combined efforts of people with disabilities themselves, their families and communities, and the appropriate health, education, vocational and social services.
  • CBR guidelines foresees CBR as a integrated and inclusive development tool that should be implemented through health, education, social protection and participation of people with disabilities.We see CBR as a useful tool to implement the essence of CRPD.
  • This is another way to visualize CBR. As you can see it has the person with disability at its centre aims to empower the CWD through its 4 pillars: Health, Education, Social Protection and Livelihood opportunities.In my presentation I will focus on the health aspects of CBR
  • Even though Ministry of Health, with support from UNICEF and WHO immediately responded to contain the virus through mass immunisation campaigns, issue of rehabilitation and inclusion of those affected was given equal importance even from the early days;CBR was seen as a possible model to be introduced in Tajikistan to address the issues of early identification and rehabilitation for all children with disabilities;Ministry of Health took the lead to introduce CBR in the most polio affected districts with support from UNICEF with Operation Mercy and Handicap International as implementing partners in the 25 most polio affected districts with support from MLSP and MoE
  • CBR Working Group was establishedamong international organisations with participation of line ministries to coordinate the efforts and share expertise Awareness of the population and especially parents raised through advocacy materialsMore than 800 health care workers, social workers, education staff, community leaders, volunteers, representatives from DPOs and Association of Parents have basic knowledge on rehabilitation and inclusionThe referral system through the PMPC has been strengthened
  • About 350 children received orthoses through the new mobile team of the orthopaedic workshop under the MLSP18 schools have been provided with ramps for accessibility (more needs to be done for toilettes, and changing mindsets) DPOs and parents associations for CWD mobilised to support the CBR processWent much beyond children affected by polio: More than 1,000 children with disabilities were reached in 25 districts and basis for CBR was established.
  • Group based rehabilitation exercises were introduced focusing on physical, intellectual and social rehabilitation in 3 districts (Rudaki, Khujand, BabajonGafurov) where possible Operation Mercy partner with the district level PMPC for referrals to enter the pogram and inclusion in schools at the “exit” of the program”In total these projects reach over 200 children at least twice a week with regular interventions.Local NGOs and DPOs are supported to be established and be registered Training for parents are provided on working with their children, and activities range from Group based rehabilitation to children seen one on one in Jamoat Health CentersA major component focuses on early intervention through Day Care and kindergarten based programs ; Home Visiting Programmes; Transition into Mainstream Education programme, continued mentoring of parents and teachers when the child is included. In addition income generation and agriculture support as well as preventive health lessons are part of the projects. Khujand: Children in Centre-based Early Intervention; Children in Day Care Program ; Children in Home Visit Program; Transitioned into Mainstream Education BabajonGafurov: Children in Kindergarten Based CBR groups Rudaki: Children in Group based rehabilitation; children seen one on one in Jamoat Health Centers National: Training of parents (mainly mothers) Supporting Local NGOs and DPOs to be established and be registered In addition income generation and agriculture support as well as preventive health lessons have been part of projects.
  • CBR project in Ghonchi district, with the support of EU and Caritas Germany trains a team of 20 rehabiliation workers through a 28-day initial training to use 30 training package sof WHO on training every day self-care, communication, mobility and learning skills at home and on improving participation in the society.
  • As a result of this project there was a clear decrease in dependency by all 130 PWD, from all age groups, who participated in CBR home training program in Vahdat during 2010-2012( Measured with WHO disability assessment, None of the participating families interrupted their training program.All participants had their first experience of rehabilitation (instead of `healing treatments`).Now, CBR is continued by the local social service unit, in cooperation with health, and education sectors
  • This was a very medical / corrective model of disability and few specialists were responsible for the care of CWDs in special institutions. Physical therapists and occupational therapists or other therapists only now start to focus on functionality and activities of daily live.
  • CBR usesavailable human resourcestooffertopeoplewith different kindsoffunctionaldisabilitiesthecombinationof:Individual trainingoflifeskillsathome; Buildingawareness on rehabilitationandinclusion in familiesandcommunities;Information tofamilies on earlyidentificationofdisabilitiesandthebenefitsofearly rehabilitative interventions;Improvingtheinvolvementandcoordinationofstateagenciesandotherlocalstructures on districtlevel, in ordertoimproveaccestobasichealth, education, andsocialwelfareservices.
  • We are working towards having more services at the community level, through home visiting nurses, increase PMPC to all districts, and , however through introduction of CBR we are trying to increase outreach of services at the community level)
  • There are still some challenges that we face which are:Even though there are many models of CBR that have been tried, we do not yet have one agreed upon model that can be institutionalisedThere are not yet many specialisedpersonelle such as physical therapists (PT) and occupational therapists (OT) . These professions are in the beginning stages of development and even in a CBR approach are needed at least on district / PMPC level. Social work (SW) as a profession at its initial stagesTheCollaboration mechanisms have been initiated, but need to be further developed There is a national strategy for inclusive education but linkages between the education system and CBR needs strengthening
  • Transcript of "Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan "

    1. 1. Ministry of Health of the Republic of Tajikistan
    2. 2. National level ( Hospital based care -Matchiton, Karabolo, etc..) Regional (PMPC*) District (PMPC, CBR Support rooms, Day care Services) Jamoat and village level (CBR Support Rooms, play corners, CBR workers and home visiting nurses) * PMPC – Psychological Medical Pedagogical Consultation Centres
    3. 3. Main functions of the PMPCs are: • Assessment and Diagnosis of children with disabilities: • Early intervention / rehabilitation: Specialists of the PMPC provide rehabilitation for children with disabilities. Special training and support is also provided to family members for them to better support their children at home; • Gate-keeping: The PMPCs have the authority to refer/recommend various options for the children with disabilities. They can refer as appropriate to an upper level in the pyramid to community based care. Their mainly aim is inclusion as much as possible.
    4. 4. CBR is a strategy within general community development for rehabilitation, equalization of opportunities and social inclusion of all children and adults with disabilities. CBR is implemented through the combined efforts of people with disabilities themselves, their families and communities, and the appropriate health, education, vocational and social services.
    5. 5. H e a l t h E d u c a t i o n S o c i a l L i v e l i h o o d CBR Empowerment
    6. 6. • Ministry of Health, with support from UNICEF and WHO, immediately responded to contain the virus through mass immunization campaigns • Issue of rehabilitation and inclusion of those affected was given equal importance from the beginning; • CBR: A model for Tajikistan to ensure inclusion and to provide for rehabilitation for children affected by polio and other children with physical disabilities; • Ministry of Health lead to introduce CBR in the 25 most affected districts, in coordination with MLSP and MoE; • Support from: UNICEF • As implementing partners: Operation Mercy Handicap International
    7. 7. • More than 800 stakeholders received basic knowledge and training on rehabilitation and inclusion: • Referral system through PMPC strengthened Health care workers Education staff Social workers Representatives from DPOs and Association of Parents Community leaders Volunteers CBR Working Group established to coordinate efforts and share expertise (UN, INGOs and ministries) Awareness-raising of the population and parents
    8. 8.  21 CBR support rooms established staffed by a mix of nurses, doctors, social workers who had a basic training in CBR, childhood disabilities, parents‟ psychosocial support and inclusive education.  About 350 children received orthotics through the new mobile team of the orthopaedic workshop under the MLSP  18 schools have been provided with ramps for accessibility (more needs to be done for toilettes, and changing mindsets)  DPOs and parents associations for CWD mobilised to support the CBR process  Went much beyond children affected by polio: More than 1,000 children with disabilities were reached in 25 districts and basis for CBR was established.
    9. 9. Gulnora was weak on her right side after polio – there was start of scoliosis. She was supported to do active exercises to strengthen her trunk muscles at the support room in Sharinav Gulnora is now going to regular school in grade 1 She can walk and participate in all activities in her school and neighbourhood with the help of an orthotic on her leg.
    10. 10. • Geographical Coverage: 3 districts • (Rudaki, Khujand, Babajon Gafurov) • Partnership with PMPC for: • Cross-referral • Inclusion in schools • 200 children reached • Local NGOs and DPOs are supported • Activities: • Early intervention through Day Care and kindergarten • Group based rehabilitation (physical, intellectual, social rehabilitation) • Individual consultations and home visits • Training for parents • Inclusive education programme • Income generation activities • Education (health, parents), prevention
    11. 11. In fall of 2012, Azizbek could not walk, he was shy. His speech was at the level of a 2 year old and hard to understand. Soon after he started coming to the CBR room with his mother, he learned songs, colors and to count. He gained self confidence, and become an outgoing child without any fear to try and climb up wherever he can. When he was introduced a walker his face was shining with pride and joy to finally stand up and “walk”, even though he now needs to learn how to use the walker properly and improve his leg and hip movements. Azizbek was one of the children who received an orthopedic device through the Orthopedic workshop.
    12. 12. • Handicap International started being active in Khatlon region in January 2010 • Provided technical support in strengthening capacities of workers at a local day-care centre • Currently: 2 CBR projects, extending over 15 districts and covering over 1000 children • One larger project, performed through: • Local NGOs • Social Assistance at home units • Another project directly through strengthening support groups at head of districts • Both working with similar workers/ volunteers and associations, but with different level of input and trainings
    13. 13. • CBR project in Ghonchi district, with the support of EU and Caritas Germany • 20 rehabilitation workers trained • 28-day initial training to use WHO package on training every day self- care, communication, mobility and learning skills at home and on
    14. 14. • Decrease in dependency by all 130 PWD, from all age groups, who participated in program from 2010- 2012 • None of the participating families interrupted their training programs • All participants had their first experience of rehabilitation • Sustainability through local social service unit, in cooperation with health and education sectors
    15. 15. At the age of 5, Burkhon could not sit or move, or eat independently. He was constantly taken care of by his mother, who was not provided with information on know how to help her son to become a more independent individual. 3 months after Burkhon„s mother started learning `home-based rehabiliation` with a CBR worker, Burkhon learned to: sit, hold his head, and use his hands to play and to eat by himself. 12 months later, Burkhon recieved locally manufactured and state- provided appliances such as seats, standing supports and a wheelchair to help him move outside his home. He started attending school once a week besides recieving home education. Today, Burkhon is a talented school-boy of 8 . When he grows up he wants to become an English language translator. Real life story 3: Burkhon
    16. 16. • Cost-effectiveness; • Maximize resources of government and (I) NGOs • Cover both urban and rural areas; • Family and communities ownership; • Maximal impact through early identification and intervention • Not merely rehabilitation provision; strategy for inclusion and community development promoting access to: • Health • Livelihood • Education • Social life and protection • Empowerment!
    17. 17. National level Regional level District level Community level
    18. 18. • Institutionalization • Professionalization • Sustainability • Collaboration mechanisms initiated, to be further developed • government • local NGOs • INGO • DPOs, Parents Associations, and self-help groups
    19. 19. An inter ministrial working group on CWD has been established with decree of the Commission on Child Rights. • It can be strategically used to promote further development of and scaling up of CBR Funding opportunities • Strategic use of the new Ministry of Health – WHO – USAID rehabilitation program to build on the knowledge gained for scaling and building a rehabilitation program to support CBR implementation in Tajikistan Physiotherapy and Occupational therapy are included in the list of professions Cost-effectiveness and impact indicators should be further measured Interest raised and commitment achieved at the local level Involvement of Disabled People‟s Organisations and Association of Parents with Children with Disabilities at the local level, coalition of Parents Associations and DPOs Kishti Day service providing support to families and support prevention
    20. 20. CBR has been implemented by INGOs since 2005, but For Tajikistan, 10 years after being certified as polio free , the tragedy of the polio outbreak became a catalyst for introducing at a larger scale CBR as a low cost viable model for reaching out to the most vulnerable and hardest to reach children with disabilities
    21. 21. • UNICEF • WHO • USAID • Operation Mercy • Handicap International • Caritas Germany • Mercy Corps
    22. 22. Operation Mercy (Khujand, Babajon Gafurov, Rudaki), Handicap International Khatlon Region, EU CARITAS (Vahdat, Gonchi, Konibadam) , EU –MLSP, (Hissor, Kurgan Teppa) UNICEF – MOH (in co-operation with, OpMercy and HI, 25 districts in DRD and Khatlon) , ADD MERCY CORPS
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