CDD exists to ensure that persons with disabilities are included in mainstream development activities in Bangladesh. We believe that this can only be achieved by taking a twin-track approach i.e., educating the community in how to be more inclusive and removing the barriers to inclusion whilst simultaneously empowering persons with disabilities to participate in society by providing them with essential supports. The barriers to inclusion need to be removed on both sides if persons with disabilities are to be given the same rights and freedoms as everyone else.
A community that is more understanding and inclusive is aware of disability issues and rights, and has the knowledge and skills to make services and programs more inclusive. This knowledge needs to be built at all levels “with local communities, individuals, organisations and within government” and a commitment made to address the inherent inequities in our systems and processes in order to have maximum impact on the lives of people living with disability.
The second part of the equation concerns building the capacity of persons with disabilities to give them the confidence, skills, equipment and services to be able to participate fully in their communities.
These two strategies are interdependent as neither can succeed in creating a more inclusive society on their own and guide all aspects of CDD’s work to ensure it contributes to the creation of a “society for all”.
Community Approaches to Handicap in Development (CAHD) is a program concept that was developed in Bangladesh by the Centre for Disability in Development (CDD) in collaboration with Handicap International and CBM. CAHD was developed to address the need for a framework to address the inclusion of disability issues in development programs and became a standard approach over the last 10 years in Bangladesh and abroad.
The success of CAHD and its popularity amongst practitioners influenced the World Health Organisation to adapt their Community Based Rehabilitation (CBR) approach to make it more relevant and applicable to disability inclusive development. The new CBR guidelines have adopted many of the CAHD practice elements and therefore CDD now uses these to guide its work. However, some further information on CAHD is provided below given its extensive use in Bangladesh for many years.
Theory behind CAHD
Development work is primarily focused on the eradication of poverty and on changing the attitudes and practices of the community. CAHD recognises that impairment and disability are integral to development issues due to their close connection to poverty and so aims to include them in the ongoing activities of mainstream development organisations.
Vision of CAHD
The vision of CAHD is to establish activities that will minimise the negative impacts of impairment and disability, by creating changes in attitudes to counter the existence of or to eliminate negative attitudes.
To achieve this vision CAHD programs must effectively and efficiently implement activities that will:
- Change the attitudes of people and their organisations to more equitably share resources with all people, especially with those who are living with disability.
- Change the social environment and the attitudes of people and organisations to eliminate the barriers that exclude persons with disabilities from participation, and which lead to minimal if any assistance for them.
- Reduce the impact of impairment and disability on individuals and their families by helping to prevent disability occurrence and providing needs-based services.
How CAHD creates change
CAHD focuses on changing the perspectives of people and organisations, and to do this it is essential to change knowledge, attitudes and practices:
- Knowledge:Changing perspectives requires creation of knowledge by providing information and creating experience. In CAHD, this information transfer is called social communication and experience is gained through participating in inclusion activities.
- Attitudes:Once knowledge is assimilated and combined with experience, it results in specific attitudes or ways of thinking about certain topics.
- Practice: Ultimately, this new-found knowledge and way of thinking will change practice â€“ this is the key objective of CAHD.
The components of CAHD
CAHD is comprised of four components on which interventions are based and it is essential that there are simultaneous activities in all of these components:
Social Communication (Awareness and attitudinal)
Providing knowledge to people and organisations about:
- Causes of impairment, disability and negative attitudes.
- Roles of family members and organisations, in creating barriers and restrictions to participation.
- Activities that will prevent impairment and disability.
- Rehabilitation practices that will minimise the impact of impairment and maximise the personal development of persons with disabilities.
Inclusion and Rights (Inclusion and participation in development and socio-political activities, enjoying equal status and rights)
Providing persons with disabilities with an equal opportunity to access their rights as citizens and to participate in all family and community activities enables:
- Persons with disabilities to improve the quality of their lives.
- People and their organisations to have positive experiences with persons with disabilities, which will change their attitudes towards them.
- Organisations to include persons with disabilities in their existing programs to give them equal access to education, economic and health opportunities.
- Persons with disabilities to promote their right to play active roles in family, community, social and economic activities.
- National organisations to advocate for legislation, policy and regulations which recognise the rights of persons with disabilities.
Rehabilitation (Therapeutic Interventions)
Providing assistance to people who have impairments to minimise functional difficulties and maximise their personal development by:
- Providing basic rehabilitation services in the community.
- Providing referrals to other services and transferring skills to family members or care givers to meet the special needs of persons with disabilities.
- Providing assistive devices to minimise functional limitations and enable persons with disabilities to participate more in society.
- Adapting working and living environments to make them more accessible.
An organisational function necessary to make sure that the previous three activities are implemented simultaneously and that these activities are relevant, efficient and effective by:
- Developing a monitoring, research and evaluation system.
- Building the capacity of local partners.
- Including persons with disabilities, their families and the community in the design and monitoring, research and evaluation process to ensure the accountability of the CAHD approach.
- Developing and facilitating networks.
- Documenting the development and evaluating the impact of the CAHD approach.
- Using monitoring, research, documentation, and evaluation information to improve the CAHD approach.
CAHD is directed at each sector or level in society, which can be categorised as follows:
- PRIMARY SECTOR:The micro-level, family situations, where people live out most of their lives.
- SECONDARY SECTOR:The first macro-level where people, as members of organisations, work to provide direct governance, goods and/or services and create social change in the primary sector.
- TERTIARY SECTOR:The second macro-level where people, as members of organisations, work to provide indirect governance and services, manufacture goods and create social change in the primary sector.
CDD applies the Community Based Rehabilitation Framework (CBR) in conducting its work to ensure that it aligns with internationally-accepted disability standards. CBR is a recognised international disability approach that is being implemented in over 90 countries worldwide to ensure that the benefits of the Convention on the Rights of Persons with Disabilities are delivered to persons with disabilities. It is a broad multi-sectoral development strategy for the rehabilitation, equalisation of opportunity, poverty reduction and social inclusion of persons with disabilities.
CDD’s programs therefore focus on six key areas where it feels that it can have the most impact on the lives of persons with disabilities, which include the five core areas recommended by the CBR framework which are health, education, livelihood, empowerment and social integration.
Although Awareness is included within the CBR framework within Empowerment, CDD feels that given its important role in overturning negative attitudes to disability and the organisation’s focus of activities in this area, that it should be highlighted as a separate core area. Awareness is based on CDD’s core expertise in training, information and advocacy and is directed at building inclusion at all levels of community, industry and society. The other focus areas are based around those proposed by the Community Based Rehabilitation framework and aim to improve inclusion of persons with disabilities in the key mainstream development areas of health, education, livelihood, empowerment and social environments.
Further information on CDD’s main areas of work can be found under Key Focus Areas.
The way in which we apply the CBR framework (see last section for overview of CBR) in our work is to encourage its inclusion in the ongoing activities of existing development organisations. Our rationale is that if the resources and capacity of these organisations could be tapped to address disability issues within their general work then a large number of persons with disabilities could be reached more efficiently and effectively than using a separate delivery mechanism. CDD’s aim is to develop the service delivery capacity of existing direct service development organisations to expand and change the focus of their programs to be more inclusive of persons with disabilities and recognise their rights and capacities to allow them to be active participants. Our other key focus area is indirect tertiary service organisations who also deliver services to persons with disabilities, such as national and local government, educational institutions, health organisations etc.
In this way we seek to implement CBR at all levels in society using direct and indirect service delivery organisations as a conduit to reaching local communities. CDD currently has partnerships with over 350 development organisations, disabled people’s organisations, institutional bodies and government departments who have been extensively trained by CDD and are committed to implementing the CBR framework in their communities, and since our inception we have trained over 12,000 development workers in how to apply the principles of CBR in their work.
As this highlights, training is the key to the successful implementation of our approach. Our vision is that development programs at a local, regional, national and international level will focus on activities which change the attitudes of people and organisations to disability in order to:
- Create more equitable sharing of resources and facilitate capacity building, empowerment and community mobilisation of persons with disabilities and their families.
- Eliminate the barriers that result in the exclusion of disabled persons and activate communities to promote and protect the human rights of persons with disabilities.
- Support persons with disabilities to maximise their physical and mental abilities, to access regular services and opportunities, and to become active contributors to the community.
CDD is also proud to be making a contribution to the achievement of the eight Millenium Development Goals (MDGs) which were adopted by UN Member States in 2000, and range from eradicating extreme poverty and hunger to providing universal primary education, by the target date of 2015. These internationally agreed development goals represent the benchmarks set for development at the start of the new century and while not explicitly mentioning disability, it is clear that the goals cannot be fully achieved without taking disability issues into account.
The work that CDD is doing to address the Millenium Development Goals is summarised in the table below:
|MDG||Link to Disability||CDD intervention|
|Eradicate extreme poverty and hunger.||§ 82% of persons with disabilities live in poverty
§ 20% of the extreme poor are disabled.
|One of the main development foci in Bangladesh is food security for the poor. CDD, in association with a consortium of development organisations, is mainstreaming women with disability family members into food security programs. The technical support we provide includes identification of families with disabilities, assessment of impairment, need based therapeutic intervention, assessment of possible areas of livelihood, capacity development and providing assets for livelihood activities.|
|Achieve universal primary education.||§ 25 million children with disabilities between the age of 7 and 12 do not attend school.
§ Only 2% of children with disabilities in developing countries attend school
§ Less than 5% of children with disabilities complete their primary education.
|CDD is promoting inclusion of students with disabilities in the mainstream education system. It is advocating the Government, sensitising authorities, parents and students; providing training to teachers and education officers; developing teaching/learning materials, and is providing support in over 500 schools to create accessibility improvements.|
|Promote gender equality and empowerment for women.||§ Women with disabilities face twofold discrimination: as a woman and as a person with disabilities.
§ Only 1% of women with disabilities in developing countries knows how to read and write.
§ Women with disabilities are particularly vulnerable to physical, sexual and psychological abuse.
|Gender is a key determinant of poverty in Bangladesh. Women are particularly disadvantaged as evidenced by high mortality rates, low literacy levels, poor health conditions, and lack of access to the labour markets.
The situation with regard to poverty and food security is even worse for women with a disability and it is now recognised that poverty is both a major cause and consequence of disability. The needs of persons with disabilities to be educated, skilled and economically involved are fundamental human rights and thus a responsibility of the nation and all its citizens.
In 2010, CDD, in association with a consortium of development organizations, commenced a project to mainstream 2,200 women living with disability into food security programs in Gaibandha district.
|Reduce child mortality.||§ Worldwide, more than 10.8 million children under the age of 5 die every year.
§ The child mortality rate for children with disabilities under the age of 5 can rise by up to 80%.
§ Children with disabilities in the south are often undernourished, a common cause of child mortality.
|Children with disabilities are at higher risk of dying not just because of medical conditions, but also because of the disability itself. In Bangladesh, the death rate for children with disabilities under five years is very high. Children with disabilities have the right to enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community. They have the right to enjoy the highest attainable standard of health and to access facilities for the treatment of illness and rehabilitation of health.
Around 70% of children with disabilities are receiving services from trained rehabilitation workers among all registered service recipients by partner organisations. CDDâ€™s training also has a special focus on the care of children with disabilities. A number of information communication materials have been developed by CDD to promote awareness of the right to life of children with disabilities.
|Improve maternal health.||§ Every year, 20 million women suffer from complications during their pregnancy or child birth, often resulting in some form of disability.
§ Women with disabilities run a higher risk of complications during pregnancy and childbirth.
§ Women with disabilities generally have less access to adapted and accessible health care.
|CDD has produced a wealth of information materials for community awareness to help prevent disability during pregnancy. Our social communication training module has a special focus on the issue. CDD has trained a total of 650 social communicators (to 2010). Trained social communicators are disseminating the information on maternal health at the community level using a flashcards set produced by CDD.|
|Combat HIV/AIDS, malaria and other diseases.||§ Persons with disabilities are generally more susceptible to diseases due to their living conditions or limited access to health care.
§ Persons with disabilities are less involved in medical prevention programs, such as awareness and vaccination campaigns.
§ Untreated illness and the low vaccination level are common causes of disability.
|CDD includes information on preventing HIV/AIDS in its rehabilitation training modules, delivered to external organisations.|
|Ensure environmental sustainability.||§ Climate change causes natural disasters, a known cause of disability.
§ The lack of clean drinking water, hygiene and sanitation facilities contribute to the spreading of infections and the higher incidence of chronic diseases, both leading to disability.
§ Persons with disabilities have less access to safe drinking water and sanitary installations due to their own limited mobility and the limited accessibility of the facilities.
|Bangladesh is known worldwide as a country of natural disasters and persons with disabilities are the most vulnerable in disaster situations. CDD is actively advocating and building capacity in Bangladesh to promote disability inclusive disaster risk reduction. To increase the existing knowledge base in this area CDD is implementing pilot projects to generate learning and improvements for future initiatives. CDD also responds in the post-disaster relief and rehabilitation stage, responding to the special needs of families living with disability.|
|A global partnership for development.||§ Persons with disabilities and their representing organisations are best placed to define their needs and concerns.
§ Worldwide cooperation networks remain nothing more than a dream when development organisations are not included in the policy debates about development.
|CDD is very active in regional cooperation and international policy formulation on disability issues. CDD has provided orientation and training on mainstreaming disability and conducted exposure visits for more then 300 managers from all over the world (years to/including 2010).|