"Rather than focusing on specific groups, the CAHD approach concentrates on all types of community groups, including those not normally included in development programs, such as landowners and the middle classes."
There is increasing recognition of the value of actively involving people with disabilities in planning and implementing community-based rehabilitation programs. At the same time, it has been recognized that disability issues and people living with disabilities need to be included in mainstream development programs if these programs are to have a real impact on reducing poverty.
In response to this need, the Center for Disability in Development (CDD) in Bangladesh developed Community Approaches to Handicap (CAHD). CAHD is designed to help development organizations include disabled people in their activities.
CAHD starts with an organizations current work and understanding of communities. Then, with small changes and with training of community development workers in the principles of CAHD, disabled people can be helped very quickly.
Rather than focusing on specific groups, the CAHD approach concentrates on all types of community groups, including those not normally included in development programs, such as landowners and the middle classes. CAHD recognizes that disability can affect anyone, and that, in order to bring about the changes needed by people living with disabilities, development programs need to take a wider approach, looking at issues that affect other groups within the community.
CAHD is now being developed internationally with the support of Handicap International and Christoffel Blinden Mission. As well as the programs in Bangladesh, there are pilot programs in Nepal, India and the Philippines.
CAHD aims to raise awareness of:
CAHD in practice
Disabled people will not be included fully in their community unless basic rehabilitation is provided. This includes appropriate therapy and the use of supportive devices and equipment in order to prevent their impairment worsening and to ensure that they can be functional and mobile. The CAHD approach works to improve access to referral services for specialist treatment as well as to develop links and transfer options between basic home therapy services and referral services at hospitals.
CAHD also works to challenge the attitudes of people and organizations. Negative attitudes can create barriers that result in the exclusion of disabled people from their communities.
Changing attitudes is a long-term commitment but research shows that people are willing to change their attitudes and practices when a change can be shown to be of advantage to themselves, their family and their community. By sharing information and experiences with disabled people through workshops and meetings, communities gain knowledge and understanding of disability and impairment and recognize the value of including disabled people in community life.
Disabled people have the same right as non-disabled people to education, health care, employment and social activities. They also have a right to physical access to buildings in order to help them improve their quality of life. Once the attitudes of people and organizations change, disabled people will be able to play an active role in the social, economic and political life of the community. National and international organizations need to work with disabled people to advocate for legislation, policy and regulations for the recognition of the rights of the disabled person, as well as to seek practical solutions to address the difficulties of comprehensive inclusion.
Tanjina Aktar's story, below, shows how CAHD helped one disabled child be more active and involved in her community.
Case study: Tanjina's story
Tanjina Aktar is eight years old and lives in East Jamsing, a village near Dhaka in Bangladesh. She is the oldest child of Nurul and Begum Islam. Tanjina has a baby brother and a sister, Irine, who is five. The family is dependent on Nurul's income from construction work, which is very small. Begum is a housewife.
When she was born both Tanjina and her mother were malnourished. At the age of two Tanjina had an infection that caused a fever. Her parents took her to the doctor who cured the fever but afterwards Tanjina could not walk or talk. Her parents said her legs seemed 'abnormal' but they could not afford to take their daughter to a hospital where she could receive specialist treatment.
Tanjina became a burden to her family and they felt there was nothing that they could do for her. The children in the village were also cruel to her.
In November 2000, Francis Halder, a Community Disability Resource Person who had been trained in Community Approaches to Handicap by the Center for Disability and Development, was told about Tanjina when he visited her community. He registered her as one of his clients and made a thorough assessment of her situation. Tanjina was diagnosed with cerebral palsy.
Halder started providing primary rehabilitation therapy for Tanjina. This has helped to control her limb movement and she is now able to stand and walk with the aid of a crutch. Tanjina can now do many basic day-to-day tasks such as feeding and dressing herself. Halder also began counseling her family and neighbors and organized regular community meetings where disability issues and attitudes were discussed openly. This, along with the rehabilitation therapy, has motivated both her family and her community to involve Tanjina in community life, through, for example, playing with the other children. The next step will be for Tanjina to start at the local school.
Tanjina's mother took part in an income-generating micro-credit scheme and she is now rearing a milking cow and trading on a small scale.
These comprehensive support services have helped Tanjina and her family: they have improved Tanjina's mobility and daily living skills and improved both family and community attitudes towards her. Had she not received this help she may have experienced further neglect and died at a young age.
The Center for Disability and Development (CDD)
D-55, Talbag, Savar, Dhaka, Bangladesh.
Understanding Community Approaches to Handicap in Development (CAHD)
Available from Handicap International UK, Waterman House, 101-107 Chertsey Road, Woking, Surrey, GU21 5BW. Tel +44 0870 774 3737
CAHD in Nepal Available from Handicap International UK, 5 Station Hill, Farnham, Surrey GU9 8AA, UK. Tel +44 870 774 3737, Fax +44 870 774 3738
Many more resources on disability and inclusion can be found on the Source website; www.asksource.info