Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan
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.
Realizing article 19 and 23 of the CRPD - What types of- and considerations for social services at local level for children with disabilities?
From 4th Child Protection Forum in Tajikistan, 2013.
The Alternative Care Framework by Ministry of Gender, Labour and Social Deve...ChildsiFoundation
The Government of Uganda through Ministry of Gender, Labour and Social Development is implementing the Alternative Care Framework that seeks family based solutions for Ugandan children in care. This was another presentation by Stella Ogwang Principal Probation Officer at Ministry of Gender, Labour and Social Development at the Christian Childcare Conference held on 19 February a2015 at Gaba Community Church.
The OVC Situation Analysis in Uganda by Stella Ogwang, Principal Probation Of...ChildsiFoundation
The current Orphan and Vulnerable Children situation in Uganda. This was a presentation by Stella Ogwang, Principal Probation Officer Ministry of Gender , Labour and Social Development at the Christian Childcare Conference hosted at Gaba Commitee Church organised by African Renewel Ministries, Child's i Foundation, CARNAC,Lifeline Ministries and Gaba Community Church on 19th February 2015.
Realizing article 19 and 23 of the CRPD - What types of- and considerations for social services at local level for children with disabilities?
From 4th Child Protection Forum in Tajikistan, 2013.
The Alternative Care Framework by Ministry of Gender, Labour and Social Deve...ChildsiFoundation
The Government of Uganda through Ministry of Gender, Labour and Social Development is implementing the Alternative Care Framework that seeks family based solutions for Ugandan children in care. This was another presentation by Stella Ogwang Principal Probation Officer at Ministry of Gender, Labour and Social Development at the Christian Childcare Conference held on 19 February a2015 at Gaba Community Church.
The OVC Situation Analysis in Uganda by Stella Ogwang, Principal Probation Of...ChildsiFoundation
The current Orphan and Vulnerable Children situation in Uganda. This was a presentation by Stella Ogwang, Principal Probation Officer Ministry of Gender , Labour and Social Development at the Christian Childcare Conference hosted at Gaba Commitee Church organised by African Renewel Ministries, Child's i Foundation, CARNAC,Lifeline Ministries and Gaba Community Church on 19th February 2015.
The Office of the Children’s Commissioner provides independent advocacy for the interests, rights and well being of New Zealand’s children and young people up to the age of 18 on laws, policies, practices and other matters that affect them.
The Children’s Commissioner has a statutory right to investigate any matters affecting children and young people (unless the issue is before the Court).
BRAC, an international development organisation based in Bangladesh, is the largest non-governmental development organisation in the world, in terms of number of employees as of June 2015
Monitoring,Evaluation and learning initiative: Young children affected by HIV...Jared Ogeda
In this issue of the newsletter we feature a situational analysis
from PATH focusing on the integration of ECD services in Nyanza
Province, Kenya; we introduce more team members working on
Hilton Foundation-funded projects; we go up close with the Firelight Foundation and the work they are doing; we begin a series
on the ‘Nutrition and Nurturance of Young Children’ with a companion piece on breastfeeding; and we discuss what we can and
can’t learn from before and after measures in evaluations.
PROJECT PROPOSAL FOR SCHOOL FOR ORPHANS
In our project area number of Orphan, Semi Orphan and Street Children are found. The
problem of orphan / street children is acute due to urbanization and industrialization. Due
to the deaths of HIV/AIDS affected persons, Remarriage of deserted / widowed /divorce
women, absence of love and security in the families, Family disputes, Unwanted pregnancy
of Trafficking / Sexually exploited girls; these orphan and street children are left without
care and support. These children are involved inmetal scrappicking; pick pocketing and
participating in anti social, criminal activities. Therefore, we envisage mainstreaming these
children in the national building by providing care, support and protection in our SCHOOL FOR THE ORPHAN
Kindly donate to us
www.stmarkinstitute.org
CBR in the Philippines: Current State of "Propagation"Paul Edward Muego
Presented at the Community-Based Rehabilitation (CBR) Forum (Theme: Allied Health Professionals as Partners in Realizing Inclusive Development in the Community) held in April 13, 2013 at the University of Sto. Tomas-CME Auditorium.
The Office of the Children’s Commissioner provides independent advocacy for the interests, rights and well being of New Zealand’s children and young people up to the age of 18 on laws, policies, practices and other matters that affect them.
The Children’s Commissioner has a statutory right to investigate any matters affecting children and young people (unless the issue is before the Court).
BRAC, an international development organisation based in Bangladesh, is the largest non-governmental development organisation in the world, in terms of number of employees as of June 2015
Monitoring,Evaluation and learning initiative: Young children affected by HIV...Jared Ogeda
In this issue of the newsletter we feature a situational analysis
from PATH focusing on the integration of ECD services in Nyanza
Province, Kenya; we introduce more team members working on
Hilton Foundation-funded projects; we go up close with the Firelight Foundation and the work they are doing; we begin a series
on the ‘Nutrition and Nurturance of Young Children’ with a companion piece on breastfeeding; and we discuss what we can and
can’t learn from before and after measures in evaluations.
PROJECT PROPOSAL FOR SCHOOL FOR ORPHANS
In our project area number of Orphan, Semi Orphan and Street Children are found. The
problem of orphan / street children is acute due to urbanization and industrialization. Due
to the deaths of HIV/AIDS affected persons, Remarriage of deserted / widowed /divorce
women, absence of love and security in the families, Family disputes, Unwanted pregnancy
of Trafficking / Sexually exploited girls; these orphan and street children are left without
care and support. These children are involved inmetal scrappicking; pick pocketing and
participating in anti social, criminal activities. Therefore, we envisage mainstreaming these
children in the national building by providing care, support and protection in our SCHOOL FOR THE ORPHAN
Kindly donate to us
www.stmarkinstitute.org
CBR in the Philippines: Current State of "Propagation"Paul Edward Muego
Presented at the Community-Based Rehabilitation (CBR) Forum (Theme: Allied Health Professionals as Partners in Realizing Inclusive Development in the Community) held in April 13, 2013 at the University of Sto. Tomas-CME Auditorium.
CBR is a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities
All hospitals should be disability friendly, to ensure easy movement of disable patients. The presentation arrives at a solution to the all above disability issues to serve as a guide line.
Similar to Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan
In this issue of the newsletter we feature a situational analysis
from PATH focusing on the integration of ECD services in Nyanza
Province, Kenya; we introduce more team members working on
Hilton Foundation-funded projects; we go up close with the Firelight Foundation and the work they are doing; we begin a series
on the ‘Nutrition and Nurturance of Young Children’ with a companion piece on breastfeeding; and we discuss what we can and
can’t learn from before and after measures in evaluations.
I hope you find this issue to be informative and helpful in your work. Please send me any information you’d like posted in upcoming issues.
The embedded links may not work in SlideShare, so please feel free to email me for a copy at DrChrisStout@gmail.com to be added to our email list.
You can join our Facebook Group and interact with over 5200 likeminded individuals at:
https://www.facebook.com/groups/CenterForGlobalInitiatives/
Any recommendations to improve this communique would be most appreciated!
And if you’d like to support the Center’s work with a tax deductible donation, that would be fantastic(!) and do a great deal: http://centerforglobalinitiatives.org/donateNow.cfm
Cheers, and thank you for your work,
Chris
Founding Director, http://CenterForGlobalInitiatives.org
Innovation Prevention and Response Program: Adressing the Link Between Teen P...WorldEd
DREAMS (Determined Resilient Empowered AIDS-free Mentored Safe) Innovation Challenge (IC) is a partnership of 56 organizations to implement innovative solutions that reduce HIV infections in adolescent girs and young women (AGYW) in 10 countries. DREAMS is responding because adolescent girls and young women are getting infected with HIV at alarming rates (~360,000 every year). WEI/Bantwana DREAMS IC focuses on the highly vulnerable under-served sub-population of AGYW who are pregnant/young mothers who have recently dropped out or are in school, but at the greatest risk of dropping out.
The holistic package of services to prevent AGYW school drop-outs includes: Prevention to create supportive environment for girls in schools and communities: training of teachers on GBV and sexual violence, Protect our Youth Clubs, early warning system for girls' retention, and parent/community sensitization on girls' education.
and Response to address educational needs of pregnant girls and teen mothers: part time continuing education for girls, mentorship for girls to support retention, wrap-around services (HTC, ASRH, financial literacy, and life skills), and early childhood stimulation classes.
Challenges include long standing cultural practices and beliefs which are barriers to these girls' access to education, in school and in the community, lack of male/partner support, and limited time frame, budget and small sample sizes.
Key strategies/Lessons learned: Government involvement at all levels, inclusive strategy for in-school POY clubs and PTCE sites, and involvement of male partners.
This was presented by Jessica Smolow at the CIES conference in March, 2018.
Upward is dedicated to serving severely disabled and/or medically fragile children and their families. At Upward, we make skills development, learning and therapy fun. We are bringing hope and joy to the children we support and helping them achieve their highest potential.
Helping Your Child at Home (For NDIS Participants) Shira59
Carepro Disability Services is a reputable NDIS Service Provider based in Melbourne, offering comprehensive support and assistance to individuals with disabilities who are part of the National Disability Insurance Scheme. Our services encompass a wide spectrum of customized solutions, ranging from therapeutic interventions to personal care and community engagement programs. Our devoted team is dedicated to enhancing the overall quality of life and promoting self-sufficiency among NDIS participants. We prioritize a client-centric approach and are fully committed to fostering inclusivity, aiming to empower individuals to realize their aspirations and lead rewarding lives within their local communities. Feel free to reach out to us today at (03) 9492 6982 to arrange a complimentary consultation. Carepro Disability Services is here to provide the support you need. Website careprods.com.au
Similar to Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan (20)
Immunization is a core component of the human right to
health and an individual, community and government responsibility. Protected from the threat of vaccine –preventable diseases, immunized children have the opportunity to thrive and a better chance of realizing their full potential.
Knowledge, attitudes and practices of parents from the northern municipalities regarding pre-school education (December 2014) by IPSOS and UNICEF Montenegro
The UN Convention on the Rights of the Child turned 25 in November 2014. This compendium highlights the events and celebrations organized by UNICEF in cooperation with partner organizations and children around the world.
It is right and just for young Roma children and their futures to be at the centre of this important research.
The Roma Early Childhood Inclusion+ (RECI+) Studies and Reports are a joint initiative between the Sponsoring Agencies, namely: the Roma ‘Kopaçi’ Initiatives at the Early Childhood Program (ECP) of Open Society Foundations (OSF), the Roma Education Fund (REF) and UNICEF.
Croatia 2015
The 2014 Serbia Multiple Indicator Cluster Survey (MICS) and 2014 Serbia Roma Settlements Multiple Indicator Cluster
Survey were carried out in 2014 by the Statistical Office of the Republic of Serbia as part of the global MICS programme.
Technical and financial support was provided by the United Nations Children’s Fund (UNICEF).
The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme
to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Presentation by Ms. Khojaeva Aziza, Head of Child and Adolescent Unit, Department of Mother and Child Health, Ministry of Health, Republic of Tajikistan
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. 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. 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.
7. • 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
8. • 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
9. 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.
10. 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.
11.
12. • 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
13. 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.
14. • 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
15. • 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
16. • 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
17. 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
18.
19. • 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!
22. • Institutionalization
• Professionalization
• Sustainability
• Collaboration mechanisms initiated, to be
further developed
• government
• local NGOs
• INGO
• DPOs, Parents Associations, and self-help
groups
23. 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
24.
25.
26.
27. 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
28. • UNICEF
• WHO
• USAID
• Operation Mercy
• Handicap International
• Caritas Germany
• Mercy Corps
29. 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
Editor's Notes
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