Enabling the disabled

Major H.P.S. Ahluwalia, Chairman, Rehabilitation Council of India. - BY SPECIAL ARRANGEMENT

The Rehabilitation Council of India completes a decade of service as a statutory body next month. A review of its significant achievements, and the tasks and challenges ahead of it.

DISABILITY among human beings has been an issue in focus throughout mankind's history. In India, efforts to rehabilitate those who are thus physically challenged, through specially designed educational strategies have a history of over a hundred years. But a starkly visible change has come about on the rehabilitation scene in India in recent years. It is marked by a shift away from the regime of treating the disabled in isolation and exclusion and towards empowering them to participate effectively in the mainstream of national life. The credit for this justifiably goes to the Rehabilitation Council of India (RCI), set up in 1993 under a Central legislation enacted in 1992.

The main purpose of the RCI Act was to regulate and standardise the programmes of training professionals in the disability sector on the lines of professional bodies such as the Medical Council of India and the Bar Council of India. The RCI, however, did not confine itself to mere policing but went beyond that to ensure the socio-economic empowerment of the disabled. The reason is not far to seek. Contrary to the popular notion - or misconception - the disabled too have fundamental rights to education, employment, health and a host of other rights guaranteed under the Constitution. But the rehabilitation efforts undertaken for some decades had not succeeded to the desired extent in enabling the disabled to secure their rights. There has been no dearth of committed social workers and activists interested in the cause of the rehabilitation of the disabled. In fact, quite a few among them are themselves victims of disability and could appreciate the needs of the disabled. But they could not be substitutes for trained professionals, without whom the latent potential of the disabled could not be brought out. As early as 1974 the government had launched the scheme of Integrated Education for Disabled Children (IEDC) but there were only 700 teachers to attend to some 45,000 children. Even with all the schemes, not more than 2 per cent of the children with disability could be covered.

The National Handicapped Council, an apex advisory body in the disability sector, found in 1983 that one of the main reasons for the schemes for the rehabilitation of the disabled not making much headway was a lack of trained manpower. It was noted that the training programmes were going on in an ad hoc and isolated manner without a uniform and consistent approach. A year later in 1984, the Conference of State Social Welfare Ministers decided to form a body to regulate and standardise the training programmes. That was the context in which the RCI came into being initially as a registered society in 1986. But soon it was found that a Society could not ensure proper standardisation and acceptance of the standards by different organisations. The Justice Baharual Islam Committee recommended the setting up of a statutory body, and the RCI Act of 1992 was enacted. The Act was amended in 2000 to make the RCI more broad-based, covering important components such as promotion of research in rehabilitation and special education and maintenance of uniformity in the definitions of various disabilities.

Thus, the RCI now has wide-ranging objectives. These include regulating, training policies and programmes, bringing about standardisation of training courses for professionals in this field, prescribing minimum standards of education and training, recognising institutions offering different courses, deciding on the grant of recognition to degree, diploma and certificate courses offered by foreign universities and institutions on a reciprocal basis, promoting research in rehabilitation and special education, maintaining a Central Rehabilitation Register for professionals, collecting information on a regular basis on education and training from institutions in India and abroad and encouraging continuing education in collaboration with organisations working in this field.

The RCI is claimed to be the first of its kind in the world covering different categories of professionals serving at all levels from the grassroots to the top. As many as 16 categories of professionals are covered. These are audiologists and speech therapists; clinical psychologists; hearing and ear mould technicians; rehabilitation engineers and technicians; special teachers for educating and training the handicapped; vocational counsellors, employment officers and placement officers; multi-purpose rehabilitation therapists and technicians; speech pathologists; rehabilitation psychologists; rehabilitation social workers; rehabilitation practitioners in mental retardation; orientation and mobility specialists; community based rehabilitation professionals; rehabilitation counsellors and administrators; prosthetists and orthotists, and rehabilitation workshop managers. According to Dr. J. P. Singh, member-secretary of the RCI, the Council's importance lies in the fact that it takes care of manpower development with regard to different categories of professionals for comprehensive rehabilitation of persons with disabilities to meet the rehabilitation needs of the entire life-cycle, that is, physical-medical rehabilitation, educational rehabilitation, vocational rehabilitation and social rehabilitation.

Magnitude of disability

Considering the magnitude of the problem, the tasks before the RCI are onerous. No realistic data are available concerning the incidence and prevalence of various forms of disability, and different surveys have yielded divergent results. A survey conducted by the National Sample Survey Organisation (NSSO) in 1991 estimated that 1.9 per cent of the total population of India, that is, 16.1 million people, had physical or sensory disabilities, which included visual, speech, hearing and locomotor disabilities. Another survey conducted by the NSSO in 1991 brought out the fact that 3 per cent of India's children had delayed development and most of them were likely to be mentally retarded. Surveys by different organisations indicated that 2 to 2.5 per cent of the population, that is, 17 to 21 million people, suffered from mental retardation. Thus the total number of disabled persons ranges between 33 million and 37 million. If India accounts for 10 per cent of the 600 million disabled people in the world, the figure for India is 60 million. Yet another estimate, made by the World Health Organisation, is that 10 per cent of the population suffers one or the other disability. This works out to a population of 100 million. The NSSO will conduct a survey this year and this is expected to come out with a more realistic picture. Even the conservative estimate of 37 million is large enough.

Apart from the question of the vast numbers involved, the prevalent mindset and approach to the rehabilitation of different categories of the disabled in the past had to be addressed. The rehabilitation efforts were mostly marked by an individualised approach, which sought to cater to the special needs of the disabled for education and vocational training without corresponding support services in the surrounding environment to enable the disabled to derive the full benefit of their training. The public mindset was not attuned to look at the disabled as equal partners who deserve opportunities to join the mainstream of national life. The observance of the International Year of Disabled Persons in 1981 gave a new direction here by focussing not only on prevention and rehabilitation but also on provision of equal opportunities to the disabled. The idea was that it was not enough to provide education and training to the disabled but it was equally important that the surrounding environment be made conducive for them to participate fully in the activities of their respective societies. To take care of this the government enacted the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act in 1995.

Performance of the RCI

When the RCI was set up there were just 20 training institutions in this sector. Now there are 160 institutions recognised by the RCI. Out of them 29, considered the best, have been accorded accredited status. These institutions are training more than 200 batches in programmes at different levels from certificate programmes to master's degree programmes. As many as 21,513 professionals with recognised qualifications in the area of rehabilitation and special education are now registered with the RCI. It has so far developed and approved 87 training programmes to meet the manpower requirements of the 16 categories of professionals allocated to it. Universities and other institutions have adopted these courses to update the knowledge and skills of professionals already working in the field.

A milestone in the record of the RCI has been the successful launch and conclusion of a national bridge course to upgrade the skills of those working in this field even prior to 1993 and register them as rehabilitation personnel. Started in 1998, this course has covered 12,665 special teachers and rehabilitation workers. The bridge course was conducted through 163 institutions in 23 States. In the initial stages there was resistance from the target group but this was soon overcome. This project has triggered a range of institutional reform processes in the disability sector, which has now acquired the much-needed professionalism.

In yet another initiative, the RCI launched a B.Ed. (Special Education) course in the distance education mode through the Madhya Pradesh Bhoj (Open) University in August 2001. In the first batch, 1,035 candidates were admitted through 44 study centres across the country. For the 2002-2003 academic session, around 1,500 students were enrolled. This course is meant to meet the requirements of trained special teachers

A 90-day foundation course for in-service teachers has also been launched in the distance education mode through Bhoj University. This replaces the 45-day course launched earlier for the benefit of elementary school teachers after the disability component was introduced in the District Primary Education Programme (DPEP) of the Union Ministry of Human Resource Development. These in-service courses for teachers are popular and a number of schools have evinced interest in enrolling teachers who have done them. Similar distance education programmes meant to sensitise parents of the disabled and grassroots level functionaries have been launched through the Indira Gandhi National Open University (IGNOU).

In order to provide opportunities for higher education in rehabilitation, the RCI initiated a proposal to set up a national university for rehabilitation sciences. There are 240 universities in the country but very few of them offer courses in rehabilitation sciences. As a first step towards the creation of such a full-fledged university, the RCI proposed the establishment of a College of Rehabilitation Sciences. This proposal has been accepted and the Ministry of Social Justice and Empowerment is in the process of setting up the college in Gwalior.

The RCI has formulated a scheme to provide vocational education to the disabled after consultations with experts in the field through a number of regional workshops. A draft National Policy on Special Education has been prepared in order to streamline the whole gamut of education and training of trainers dealing with children with disabilities. Another innovative step was to sensitise teachers in elementary schools to appreciate the needs of the disabled children. At the instance of the government, the RCI has developed a one-year diploma programme in community-based rehabilitation (CBR). In consultation with experts, the RCI has brought down the number of CBR models to three.

While all these take care of educational aspects, the RCI has ensured that the medical aspects are taken care of. At the grassroots level the disabled go to the Primary Health Centres (PHCs) when they have any problem, and unless the doctors and nurses in the PHCs are properly oriented they will not be able to appreciate the special needs of the disabled. So the RCI launched a national programme of orientation of medical officers working in PHCs towards disability management. Launched in 1999, this programme has covered 433 master trainers and 12,000 medical officers. The main objective of this programme is to disseminate knowledge about prevention and early identification of disability, besides intervention and rehabilitation. In Tamil Nadu, where the maximum number of doctors have been trained, more than one lakh cases of disability have been identified by PHC doctors and referred to different rehabilitation centres.

In keeping with current trend of decentralised functioning, the RCI has set up seven zonal advisory committees with select non-governmental organisations (NGOs) as the nodal agencies. This is expected to give an opportunity to regional institutions to take up more responsibility for some of the activities of the RCI. These committees will also facilitate the strengthening of the quality of the training programme in their zones by providing technical support where needed.

The successful track record of the RCI over the past decade could be attributed to the dedicated and sound leadership provided by successive Chairmen and the unstinted support extended by successive Ministers of Social Justice and Empowerment. The incumbent Chairman, Major H.P.S. Ahluwalia, had once been an active mountaineer and had scaled Mount Everest (see following interview). Subsequently he fell a victim to disability and though confined to the wheel chair he has been quite active in his efforts to empower the disabled. Apart from initiating innovative programmes, Maj. Ahluwalia is keen to sensitise different strata of the society, particularly legislators, policymakers, administrators and opinion-builders to the question of disability. As part of this exercise, he met the Prime Minister recently and presented a concept paper on constituting a National Commission on Disability under the chairmanship of the Prime Minister so that disability issues could be addressed on a priority basis.

The Minister for Social Justice and Empowerment, Dr. Satyanarayan Jatia, has been quite supportive of the initiatives taken by the RCI and is keen that rehabilitation services reach the rural areas. For this he has suggested mounting an awareness campaign through different media of communication and sensitising parliamentarians on disability-related issues.

Vision document

According to Dr. J. P. Singh, at least three million children, that is, 10 per cent of children with disabilities in India, will have to be covered in the next two decades through the IEDC programme, distance learning, non-formal education, home- based education and special schools. Manpower development should keep pace with this target and it would be necessary to train at least two lakh teachers over the next 20 years. It will be seen that the task before the RCI in the coming years will require vision and a missionary zeal.

The RCI has come out with a vision document envisaging human resource development during the decade 2000-2010 to achieve universalisation of rehabilitation services. The specific objectives enunciated in the document include the universalisation of special education in all its forms, the creation of a better psycho-social environment for the rehabilitation of the disabled, the promotion of research to ascertain the models of rehabilitation or special education that are most suited in the Indian context, the promotion of human resource development in the field of geriatric rehabilitation, and the orientation of village craftsmen to disability so that the disabled could be absorbed in the various poverty alleviation programmes.

The strategies envisaged to achieve these objectives include the generation of mass awareness to reach the unreached, training professionals to provide timely intervention to prevent childhood disability, the development of simple mechanisms and tools for the early identification of disability symptoms by primary school teachers and paramedical persons, the adoption of the multi-option system for the education of the disabled, the promotion of CBR schemes, imparting vocational education to the disabled, particularly in the rural set-up, the promotion of basic and applied research through fellowships and research grants, the exploitation of information technology tools, the enhancement of professional skills through continuing rehabilitation education, and so on.

The vision document also envisages special attention to geriatric rehabilitation. In another decade, 15 to 20 per cent of the population will comprise senior citizens and the incidence of disability among them is expected to be quite high. With the joint family system crumbling, they will need special attention. It is therefore proposed to promote training of recreation therapists, rehabilitation nurses and other professionals required to give comprehensive care to the elderly.

The need to monitor training programmes effectively is highlighted in the vision document. For this purpose, the setting up of a National Board of Examination in Rehabilitation Sciences to conduct examinations in all the 16 categories has been suggested.

The RCI is thus set to promote an unbroken chain of rehabilitation services for people with activity limitations. The National Convention on Disability Issues being held in New Delhi for three days from May 8 is expected to take stock of the situation and recommend steps to bring the disabled into the mainstream of life.