1. Taking Rehabilitation Services to Rural areas R. Narasimham Consultant (Vocational Rehabilitation & Livelihood Programs) Chennai Paper presented at the National Meet of Rehabilitation Experts at Chandigarh, India on 24 March 2011

2. Introduction  As per Census 2001 there is a varying urbanization in different parts of the country, leaving a 61.53% in the rural areas.  The problems faced by the disabled is compounded by multifarious handicaps such as hunger, disease, squalor, illiteracy and a daily battle for the basic necessities of life in the villages.  Despite the difference in the urbanization, a total of 74.8% of the disabled population lives in the rural areas. 2Rural Services

3. Type of Disability, Sex and Location -2001 Type of Disability SexTotal Population ('000) TotalRuralUrban Total disabled Persons Population21,90716,388 74.8% 5,518 25.2% Males12,6069,410 74.6% 3,196 25.4% Females9,3016,978 75.1% 2,323 24.9% VisualPersons10,6357,873 74.1% 2,765 25.9% Males5,7324,223 73.7% 1,510 26.3% Females4,9033,651 74.5% 1,252 25.5% SpeechPersons1,6411,244 75.8% 397 24.2% Males942714 75.8% 228 24.2% Females699530 75.8% 169 24.2% HearingPersons1,2621,023 81.1% 239 18.9% Males674549 81.5% 125 18.5% Females588474 80.6% 114 19.4% MovementPersons6,1054,655 76.2% 1,451 23.8% Males3,9032,975 76.2% 928 23.8% Females2,2031,679 76.3% 523 23.7% MentalPersons2,2641,598 70.6% 670 29.4% Males1,355949 70.1% 405 29.9% Females909644 70.8% 265 29.2% Source: Registrar General of India, Census of India – 2001. 3Rural Services

4. Outreach Programs  Conducting Outreach Programs or under the name of Community Based Rehabilitation is not new. As early as the early 1940s, the Christian Medical College & Hospital at Vellore in South India has been taking their medical & preventive services to the rural areas in a radius of more than 50 miles, focusing mainly on communicable diseases & Leprosy which was endemic in that area then.  Subsequently NGOs working with the disabled also started the CBR work, but confined it the disability they served and services are confined to basic techniques of therapy.  The concept of CBR in Vocational Rehabilitation was started in VRC Delhi in 1976 and is now a regular feature of its servic es in all VRCs. 4Rural Services

5. Education & Skills of pwd EducationVRCEmployment Exchange Camp in rural areas Illiterate9.9%0.4%40.3% < 8 th Std25.7%12.7%42.1% Less than 8th 35.6%13.1%82.4% 8 th to 10 th 14.5%21.8%6.2% SSC +49.9%65.1%11.4% Vocational Skills 20.8%30.2%3.2% NSSO (National Statistical Survey Organization) 1.9% (Vocational Skills) 5Rural Services

6. Beneficiaries of DDRCs in the Country Educational Status of Beneficiaries EducationNumber%age Illiterate6432.5 Literate42.1 < 88141.1 Secondary2211.2 Sr Secondary157.6 Graduate63 Post Graduate52.5 197 6Rural Services

7. SSA & Disabilities  The Sarva Shiksha Abhiyan (Scheme of Universal Education introduced by the Govt. of India) has made an impact on the pwd as well. At the National level a review made on the basis of a Sample survey during Feb – May 2009 covering 99,226 households in the States/ UTs, it was found that only 4.28% of non disabled children in the age group of 6 – 13 years were out school.  The survey reveals that estimated 2,897,096 children in the age group 6-13 (i.e. 1.52% of the total number of children in the age group 6-13) are with physical or mental disabilities. 7Rural Services

8. Children with Special Needs Disability % out of school going children % of CWSN out of School Locomotor38.00%24.68% Hearing7.72%20.43% Speech13.05%36.96% Visual13.59%29.7% Mental17.95%48.03% Multiple9.70%58.57% All Disabilities1.52%34.12% 8Rural Services

9. Our experience  Our experience was a little different, perhaps because of the proactive role played by the NGO, viz., Spastic Society of Tamilnadu.  During the survey conducted in 2005 in Tiruvallur Dt., of TN, it was found that the enrollment rate of Girl Children with Disabilities (GCWD) was nearly as good as observed among the non disabled.  Out of 1210 GCWD identified 1129 – a 93.3% were enrolled as compared to 94% among non disabled in Tamilnadu.  It could not be confirmed whether the figures in the other Districts of Tamilnadu are similar. 9Rural Services

10. DDRCs  District Disability Rehabilitation Centres (DDRCs) have been set up by the Min of Social Justice & Empowerment, Govt. of India, for delivery of different types of services at grass root level in the districts.  129 such DDRCs were functioning in 32 States & Union Territories in 2008.  More DDRCs have been established in a few more Districts. They provide services in the following areas –Prevention, & early detection, –Referral for medical intervention, & surgical correction, –Fitment of aids and appliances. –Therapeutic services –Vocational Training –Job placement/Self Employment 10Rural Services

11. Survey of DDRCs  In a Status survey conducted in 50 DDRCs on a stratified sampling method covering all the States/ UTs in the country for the Min. of SJE, I had the opportunity to visit more than 30 DDRCs and compiled information through other experienced Rehab Professionals who covered the other 20 DDRCs  It is found that the DDRCs have made a dent in reaching the rural disabled at grass root level.  The Study has found that on an average 1697 pwd per year per DDRC were provided with different types of services during 2002 – 2007  A total of 97,757 with a statistical average of about 19551.4 ability aids per year have been distributed at an average of 3910.3 per Centre per year.  The largest constituent of beneficiaries is those receiving Hearing Aids followed by Others (mostly Calipers, crutches, special shoes etc...) and then Tricycles. 11Rural Services Districts covered in the Study

12. Manpower development Rehabilitation Council of India (RCI) monitors manpower development in the field of disabilities. As per the information available, out of the 383 recognized institutions, 271 (70.8%) are in State Capitals or large cities. The rest are also in the urban areas but in district headquarters or its outskirts. The manpower development services are basically urban based and have not reached the rural areas for several reasons - including viability. 12

13. Vocational Rehabilitation  Vocational training & employment are the final and most vital component of social inclusion of the pwd.  The Ministry of Labour is mandated to carry out these tasks among the population with as many as 5200 ITIs providing training in 128 technical and non technical trades with an annual intake of about 7.5 lakhs.  There are 20 Vocational Rehabilitation Centres for Handicapped (VRCs) in the country. Other than these, penetration of skill training has been limited to sporadic efforts by the NGOs  All these VRCs are in urban areas but they do carry out outreach services. 13Rural Services

14. CBVT  The Author had opportunity to introduce community based vocational training (CBVT) while working in Ahmedabad at Pirana ( a distant village) in 1989.  Since then several such programs were conducted in Gujarat, Maharashtra and Karnataka.  Now all the VRCs carry out CBVT programs as part of their regular service.  Over 250 modules have been developed. More can be done.  Education is not a constraint. Training is provided suited to abilities. 14Rural Services

15. CBVT explained  Preliminary visits are made to the rural area to identify pwd and employment market in the area.  Skills required to suit local market and can be acquired in a period of not more than 3 months identified.  Syllabus with daily or weekly skill targets are worked out.  Local artisans/ trainers identified and provided with skill transfer methods.  Training conducted.  After training economic rehab assistance provided.  Wherever possible tool kits and materials provided under different schemes or through Service Clubs. 15Rural Services

16. Post Training rehab  During a survey carried our after about one year it was found almost 83% were found engaged in economic activities.  They were formed into Self Help Groups to take up production work  Group Self employment opportunities were created and required assistance provided  Specific training suited to local employers were provided. 16Rural Services

17. Programs leading to social inclusion in Rural Areas  National Handicapped Finance Development Corporation (NHFDC)  The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities  District Industries Centre (DIC)/ MSME  District Rural Development Authority (DRDA)  National Bank for Agricultural & Rural Development (NABARD)  Other financial institutions such as Banks, State Industrial Development Authority (SIDCO), Lead bank etc… 17Rural Services

18. Swarnjayanti Gram Swarozgar Yojana (SGSY).  Under SGSY, individuals who are below the poverty line are eligible for an one-time financial assistant up to Rs 25,000 if they take up a business project.  Of this, Rs 7,500 comes from the government as subsidy and rest comes from banks as credit. Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) Enhancement of Rural Employment by providing at least 100 days of wage employment to at least one member of every household ready to work. Wages is now Rs 125 per day. Durable assets and strengthening the livelihood resource base of rural poor is an important objective of the scheme Indira Awas Yojana  Rural Housing  3% of the allocation in each district under each of these poverty alleviation schemes is to be utilized for the pwd 18Rural Services

19. Conclusion  Services, especially vocational, are available in the rural areas also for the pwd. There are weaknesses and constraints in delivery  Rehab professionals have to make efforts to swim along and gain access to these services.  We can organize CBVT programs in addition to the present educative and therapeutic services rendered in the CBR 19Rural Services

20. Amantramaksharam Nasti: Nasti Moolam anaushadham: Ayogyoh Purusho Nasti: Yojakastatra Durlabhaha Every letter a Mantra; Every root a medicine; No person is totally useless; User is hard to locate

21. R. Narasimham Consultant (Vocational Rehabilitation & Livelihood Programs) # 5, Gokulam Colony West Mambalam Chennai - 600033 Phone: 044 – 42614181 Mobile: 9840714181 Email- r n s i m h a m @ g m a i l. c o m w w w. a i d t h e d i s a b l e d. o r g 21Rural Services