(WP)HSEJDHP/I0 Report Series No.: RS/2008/GEl13(PHL)
English only
REPORT ASIA-PACIFIC CONSULTATION ON THE WORLD REPORT ON DISABILITY AND REHABILITATION
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
Manila, Philippines 24 to 25 June 2008
Not for sale Printed and distributed by: Wodd Health Organization Regional Office for the Western Pacific Manila, Philippines October 2008 WHO/WPRO UBRI\RV
MANlLA. PHILIPPINES
1 7 APR 2009
NOTE The views expressed in this report are those of the participants in the Asia-Pacific Consultation on the W orid Report on Disability and Rehabilitation and do not necessarily reflect the policies of the World Health Organization. The photograph "Joy oflearning" by G.M.B. Akash is an awarded photograph from the WHO photography contest "Images of Health and Disability 2002 and 2005".
This report has been prepared by the World Health Organization Regional Office of the Western Pacific for the participants in the Asia-Pacific Consultation on the World Report on Disability and Rehabilitation, which was held in Manila, Philippines, from 24 to 25 June 2008.
CONTENTS
SUMMARY 1. INTRODUCTION ................................................................................................................. 1 1.1 1.2 1.3 1.4 2. Background infonnation ............................................................................................... 1 Objectives ..................................................................................................................... 2 Participants .................................................................................................................... 2 Organization.................................................................................................................. 2
PROCEEDINGS .................................................................................................................... 3 2.1 Review of draft chapters ofthe World Report on Disability and Rehabilitation .......... 3 2.2 Recommendations of the World Report on Disability and Rehabilitation ................. 13 2.3 Ideas for launches and other events ............................................................................ 18
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CONCLUSIONS ................................................................................................................. 19 3.1 Review of draft chapters of the World Report on Disability and Rehabilitation ........ 19 3.2 Recommendations and future steps ............................................................................. 19 ANNEXES: ANNEX 1 ANNEX2 ANNEX 3 ANNEX 4 LIST OF TEMPORARY ADVISERS, REPRESENTATIVES! OBSERVERS AND SECRETARIAT ...................................................... 21
- PROGRAMME OF THE CONSULTATION ........................................... 33 - LIST OF DOCUMENTS DISTRIBUTED DURING THE CONSULTATION ........................................................... 35 OPENING REMARKS ............................................................................. 37
Keywords: IAsia-Pacific consultation, disability, rehabilitation, world report
SUMMARY
The Asia-Pacific Consultation on the World Report on Disability and Rehabilitation was conducted in Manila, Philippines from 24 to 25 June 2008, by the World Health Organization. The objectives of the regional consultation were: (I) to review and comment on the draft chapters of the W orId Report on Disability and Rehabilitation prepared by the working groups; (2) to provide regional and cultural perspectives and additional data and information related to the contents of the World Report; and (3) to discuss the future course of action towards the launch and implementation of the W orid Report at the regional and country levels. The regional consultation was attended by 15 temporary advisers who are experts in the field of disability and rehabilitation from Australia, Bangladesh, Cambodia, China, India, Indonesia, Mongolia, New Zealand, the Philippines and Thailand. There were 14 representatives and observers from various organizations, including the Japan International Cooperation Agency, New Zealand's Ministry of Health, five WHO Collaborating Centres in Disability and Rehabilitation in the Western Pacific Region, Disabled Peoples International, Rehabilitation International, CBM International, and the National Institute for the Visually Handicapped, India. Five World Bank staff and four WHO secretariat members also participated in the consultation. The proceedings comprised a review of draft chapters of the World Report for comment and recommended amendments. Regional and cultural perspectives and additional data and information were provided. Discussions were held on recommendations to be included in the World Report and future events. The notes taken at the meeting will be collated along with feedback and evidence from the three other regional consultations, other reviewers, the Editorial Committee, and the Advisory Committee. The notes, evidence and proposed recommendations will be used by the Editorial Committee to develop the next draft of the report. The information provided by consultation participants during the discussion on launches and other events will be used in planning the launch and dissemination strategy.
1. INTRODUCTION
1 .1
Background infonnation
An estimated 10% of the world's popUlation, or approximately 650 million people, experience some fonn of disability. The most common disabilities are associated with chronic conditions such as cardiovascular and chronic respiratory diseases, cancer and diabetes; injuries, such as those due to road traffic crashes, falls, landmines and violence; mental illness; malnutrition; HIV/ AIDS and other infectious diseases. The number of people with disabilities is growing as a result of factors such as population growth, population ageing and medical advances that preserve and prolong life. These factors are creating considerable demands for health and rehabilitation services. Furthennore, the lives of people with disabilities are made more difficult by the way society interprets and reacts to disability. This warrants environmental and attitudinal changes. Despite the magnitude of the issue, awareness of and scientific infonnation on disability issues are lacking. There is no agreement on defmitions and little internationally comparable information on the incidence, distribution and trends of disability or impainnents. Despite the significant changes over the past two decades in the field of disability and rehabilitation, there is no comprehensive evidence base. There is no global document that compiles and analyses the way countries have developed policies and the responses to address the needs of people with disabilities. Considering the aforementioned issues, the Fifty-eighth W orId Health Assembly called on WHO in May 2005 to produce a W orId Report on Disability and Rehabilitation based on the best available scientific evidence (resolution WHA58.23). This report will promote the utilization of evidence-based research and play an important role in shaping policy and enhancing the lives of people with disabilities. The objective of the World Report is to provide governments and civil society with a comprehensive description of the importance of disability, rehabilitation and inclusion, an analysis of the responses provided and reco=endations for action at national and international levels. The World Report will be developed between 2007 and 2009 in three phases: preparatory, drafting and production. The focus will be on broad consultation and the inclusion of a large number of experts from around the worId. The process recognizes the advisory role of organizations of persons with disabilities in decision-making on disability matters and ensures that organizations of persons with disabilities represent persons with disabilities at regional and global levels. The partners involved in this initiative bring enonnous technical and political weight, ensuring the best quality of information and the widest possible dissemination. WHO and the W orId Bank will jointly produce the W orId Report in collaboration with a variety of institutions that are already involved in disability, rehabilitation and mainstreaming initiatives. A strong interdisciplinary and geographical orientation will thus be reflected in the Report, drawing knowledge and experience from a diverse constituency of scholars and practitioners. For the preparation of the World Report, lead authors, working groups and an Editorial Committee have been selected. In 2007, the first drafts of the chapters and sections of the report prepared by the working groups were reviewed. Based on the comments of the Editorial Committee, the first drafts were revised. The revised drafts were compiled into the preliminary draft of the report, which has been reviewed through a series of regional consultations. The co=ents and suggestions from these consultations will be collated by WHO Headquarters and then incorporated by the lead writers into their chapters and sections. After the re-evaluation of these drafts by the Editorial Committee, the next draft report will be circulated for external review. The launch of the World Report is planned for 2009.
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The consultation served as a biregional WHO consultation for South-East Asia and the Western Pacific. 1.2 Objectives (1) To review and comment on the draft chapters of the World Report on Disability and Rehabilitation prepared by the working groups.
(2) To provide regional and cultural perspective and additional data and information related to the contents of the World Report. (3) To discuss the future course of action towards the launch and implementation of the World Report at the regional and country levels. 1.3 Participants
The regional consultation was attended by 15 temporary advisers who were experts in the field of disability and rehabilitation. The temporary advisers were from Australia, Bangladesh, Cambodia, China, India, Indonesia, Mongolia, New Zealand, the Philippines and Thailand. There were 14 representatives and observers from various organizations, including the Japan International Cooperation Agency, New Zealand's Ministry of Health, five WHO Collaborating Centres in Disability and Rehabilitation in the Western Pacific Region, Disabled Peoples International, Rehabilitation International, CBM International, and the National Institute for the Visually Handicapped, India. Five World Bank staff and four WHO secretariat members also participated in the consultation. A list of temporary advisers, representatives, observers and secretariat members is given in Annex 1. 1.4 Organization
The consultation programme is given in Annex 2, and a list of documents distributed during the meeting is in Annex 3. The documents included draft chapters 1 through 9 of the W orId Report on Disability and Rehabilitation, which were prepared by a number of authors, and introductory presentation materials. The consultation was co-chaired by Dr Chamaiparn Santikarn, Regional Adviser in Disability, Injury Prevention and Rehabilitation, WHO South-East Asia Regional Office, and Dr Hisashi Ogawa, Regional Adviser in Healthy Settings and Environment, WHO Western Pacific Regional Office. The technical sessions started with a review of the draft chapters of the W orId Report. Each draft chapter was introduced and commented on, and recommendations for changes were made. Regional and cultural perspectives and additional country-level data and information were provided during the discussions of these chapters. The participants then put forward recommendations for the final chapter of the World Report. The consultation ended with a discussion on future events, including the launch of the W orId Report on Disability and Rehabilitation.
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2. PROCEEDlNGS
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Review of draft chapters of the World Report on Disability and Rehabilitation General comments Move "participatory infrastructure" chapters (4, 5 and 6) to the end of the report and outcome chapters (7, 8) to the front as these are the goals. Consider adding chapters or sections on: o the disability movement o attitudes and awareness o policies o cross-sectoral coordination o fiscal structuring and costs o community-based rehabilitation (CBR) o international cooperation o relationships and families o health promotion for people with disabilities o people with disabilities in the media o people with disabilities in disasters and rehabilitation during and after disasters. Add lists of WHO collaborating centres, nongovernmental organizations (NGOs), persons involved in report development, and other available resources as appendices. Improve overall narrative flow and readability. Use respectful, non-stigmatizing language throughout. Improve overall balance between medical topics and social and environmental topics. Include more synthesis of existing evidence (in addition to adding new evidence). Clearly indicate the level of evidence available to support statements made throughout. Balance scientific evidence base with life experiences of people with disabilities. Highlight principles from the UN Convention on the Rights of Persons with Disabilities (CRPD) throughout, referencing specific articles as appropriate; refer to other international instruments when relevant. Ground all chapters in the International Classification of Functioning: Disability and Health (ICF) framework. Look at issues holistically and across sectors, keeping people with disabilities at the centre. Ensure all content reflects five elements for inclusion: (1) enabling, (2) easily navigated, (3) relationship based, (4) connected to the whole process, (5) inclusive not special. Take a lifecycle approach to disability throughout. Throughout the report, include more on: o intellectual and developmental disabilities o mental health o women with disabilities o indigenous people o Pacific islands beyond Australia and New Zealand o best practices o stigma including internalized stigma o rural development o people with disabilities as resources as well as recipients of services o poverty.
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"Test" each chapter for relevance to national governments and policy-makers. Emphasize implementation of existing policies, especially in developing countries. Rethink goal of defming gaps between what exists and what is required. Instead, think about what is concretely possible, practical and achievable. Provide guidance and a framework for how to set priorities overall in the area of disability and rehabilitation, but ensuring that rights are kept central. All policies and services recommended should be: o directed by people with disabilities; o outcome focused; o aspirational; o oriented towards economic and community development; o include effective participatory infrastructure, i.e. the means to achieve participation outcomes; o sustainable; and o based on partnerships. Classify recommendations in each chapter and for the overall report by audience: policy-makers, implementers and providers, academics and researchers. Chapter 1: Introduction Add an introduction to chapter 1, including aims and structure of report, so that chapter 1 can be exclusively about concepts. Make chapter more compelling - needs a "wow" factor. Clarify definitions of evidence and science, and approaches to jUdging quality of information. Include habilitation as well as rehabilitation. Abolish distinction between what belongs to health and what belongs to rights and participation. Justify inclusion of many non-health chapters by discussing the move to the social model. Explain more clearly how disability is a universal experience. Challenge the idea that life is good for people with disabilities in the developed world and bad in the developing world - highlight knowledge transfer both ways. Address difficulty of providing information relevant to all countries and policy-makers given differences in income, consciousness about disability, and existing programmes and policies. Frame the role(s) of the State across different levels of national income - what exists and what countries should aspire to; sometimes this will also mean mentioning other actors and their roles. Clarify description of community-based rehabilitation (CBR) to explain concretely what has been achieved so far; do not make it sound like a panacea for policy-makers or imply that in practice people with disabilities always lead programmes. Clarify that independent living (IL) as well as CBR is community based. Include a case study of independent living in a developed country. The rehabilitation section should stress participation as well as treatment of impairments. Note that inclusion is not always best, e.g. for education. Include more on: o ICF, including details of personal and environmental factors and concrete examples; o historical experience and concepts of disability; o institutions serving people with disabilities; o public-private partnerships;
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o o o o o o o 2.1.3 • • • • • •
existing policies; progress already made; Millennium Development Goals (MDG), including the problem of disability not being included; CBR activities in different countries; social welfare; use and importance of therapy as part of rehabilitation and habilitation; and importance of community and social orientation of disability specialists.
Chapter 2a: Global Picture ClarifY purpose and intent of chapter. Provide clear and concise definitions of disability and related terms. Emphasize social and disabling factors equally with individual health conditions. Emphasize need for balance between information that is internationally comparable and what is needed at the national level. Focus on data that will help improve the lives of people with disabilities, especially information on participation and disability-related needs. fuclude data on: o prevalence for specific impairment groups and by severity; o resource use by severity of disability; o prevalence of preventable disabilities; o cost implications of interventions for disability; o causes of morbidity and mortality in people with disabilities; o share of households with a disabled member; o national information on vulnerable people with disabilities, e.g. indigenous people; o need for assistive devices; o numbers of manufacturers of assistive devices; o numbers of CBR programmes; and o war and political conflict as a cause of disability. Estimate levels of disability rather than presenting proxy data, e.g. on road traffic deaths ("Be brave!"). Enhance explanations of disparities in national data. Improve representations of trends over time. Quality of life section should discuss measurement issues, social exclusion, discrimination, lack of choice, and experiences of people with disabilities. fuclude more on: o strategies for defining and measuring outcomes o policy implications of the increased prevalence numbers o implications of being self-identified as disabled vs. only by external deftnitions o resource allocation issues between research and providing services o strategies for doing lower-cost research. Chapter 2b: Impairment Prevention Consider restructuring the report by moving some or all of this content elsewhere, possibly disaggregating bioethics and risk reduction. Frame policy issues more clearly and include strategies for implementation. Place equal emphasis on preventing disability (unapologetically) and preventing disablement. Emphasize the positive goal of improved quality oflife for everyone, including people with disabilities, rather than the negative goal of preventing disability.
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Modify tone that implies people with disabilities are inferior; focus instead on dignity, empowerment, and other positive possibilities, maintaining the distinction between people with disabilities vs. disability as a health and/or social state. Clarify and emphasize right to life from the Convention. Section on risks of impairment is so cursory and ad hoc it might as well not be there. Editors should make a strategic decision regarding how to proceed: do not include it, do a survey covering key issues, or expand the section so that it is comprehensive. Include more substantive references. Note that prevention of impairments demands cross-sectoral work, including in the areas of: land mines, road traffic safety, reducing demand for substances, occupational safety, clean air. Emphasize importance of public awareness about disability and prevention efforts. Expand possible medical interventions to include screening, early diagnosis, and other services, not just surgery. Note the dignity and pride of people with disabilities who give back to the community by serving as an example of an undesirable state in prevention campaigns. Include more on: o differences between prevention efforts and eugenics, giving history of eugenics; o public health success stories, e.g. polio, leprosy, river blindness and cataracts, with data on associated trends; o importance of early identification as part of prevention efforts; o prevention of impairments related to ageing and prevention in elderly populations; o strategies for fmding people with disabilities hidden away due to stigma, in order to intervene to prevent multi-morbidity and provide treatment; and o cost-benefit advantages of prevention. Provide recommendations including improving trauma care. Propose healing centres, healing environments, and other positive alternatives to the negativity of the concepts of disability and rehabilitation. Chapter 3a: Medical Care and Health Systems Move medical and health care to a later chapter in the report. Target policy-makers. Clarify key messages of the chapter and state them in the introduction. Improve narrative flow. Simplify language generally; get rid of "suffering" and "victim". Clarify terms for rehabilitation medicine doctors. Expand the defmition of medical rehabilitation to include activities and participation; clarify that allied health professionals are part of the interdisciplinary medical care team. Ensure the inclusion of the 5 A's: awareness, attitudes, accessibility, affordabilityand appropriateness. Move from disease focus to biopsychosocial model; move from hospital focus to community focus, especially when discussing multiple and complex needs. Improve analysis of the implications of the information presented. In explaining systems, note that rehabilitation, rehabilitative medical care, and general care are often provided by different professionals. Provide data on national disparities in number of and access to rehabilitation medicine doctors.
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Include more on: o balance between general and special health care; o context of minimal or no general health care services available in very poor countries; o continuity of care - acute to long-term; o health fmancing including typologies (donor-driven, general revenues, social insurance, private pay) and their impacts on people with disabilities, noting implications of funding (person vs. bed, fee-for-service vs. capitated care); o insurance - both social and private, including market failures of private; o people with disabilities as experts in management of their own care, and strategies for developing necessary empowering attitudes and skills (include feminist "developmental casework approach"); o role of CBR in increasing access to, awareness of and uptake of treatment; o training doctors and other medical personnel; o "brain drain" of generalist and disability-specialist professionals; o assessment as well as diagnosis, including for mental health and intellectual impairments in developing countries; o diagnosis as a route to nonmedical services, e.g. appropriate educational supports; o screening through schools; o dental health; and o seatbelt programmes. Recommend inclusion of people with disabilities in mainstream primary care initiatives, including those based on the WHO CHOICES model. Recommend inclusion of people with disabilities in planning as well as in receiving services. Recommend managing health systems locally rather than centrally. Recommend increased health systems, basic science, and clinical research. Provide recommendations for designing fInancing schemes, including: o providing funding for rehabilitation programmes; o ensuring effective financial incentives for providers; o involving people with disabilities in developing appropriate health benefit packages; and o cofInancing schemes between health, social, educational sectors, transit, central and local governments. Recommend that care systems incorporate cost-effective rehabilitation measures known from research. Recommend house-to-house early identifIcation programmes. Recommend programmes working with parents on care of children with disabilities. Recommend education about rehabilitation and therapy at the undergraduate medical level. Recommend establishing links between medical staff and local CBR programmes. Fix incorrect statement that research does not look at activities and explain limitation of tools currently available to look at participation. Chapter 3b: Rehabilitation Therapies Restructure chapter, perhaps around: o needs of people with disabilities, o the process of therapy, o variations in practice in different parts of the world, or o the multidisciplinary team approach. Re-title chapter to reflect restructuring.
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Improve readability for a non-academic audience. Establish the difference between therapy and other support services. Use generic terms like "communication therapies", recognizing that "spee~h therapy", "audiology", etc. may actually be delivered by community health workers m some settings. Recognize the various titles and terms for various professionals. Improve geographical representation of information, especially of low-income countries with few professional therapists. Emphasize the role of the person at the centre driving therapy rather than as the subject of therapy; including discussing skill-building for self-management. Emphasize the role of therapists in improving quality of life, health, well-being, participation outcomes, independence and choices. Emphasize the importance of early detection and management. Carefully word the section on art, music and sport so as not to give the message that people have interests and hobbies, but people with disabilities have therapy. Recognize differing levels of development and maturity in various professions. Enrich table of numbers of therapists with statistics from other related professions. Include more on: o affordability, costs and fmancing schemes; o referral schemes, emphasizing choices for people with disabilities; o relationships between people with disabilities, families and rehabilitation professionals; o training programmes to increase numbers and skill levels of therapists; o training trainers who can impart practical skills, including screening, to CBR workers; o psychometric evaluation for appropriate placement of children with intellectual disabilities; o technologies in rehabilitation, e.g. robotics, EMG biofeedback; and o swallowing as part of speech and language therapy. Chapter 3c: Assistive Technologies Organize chapter around function of devices rather than by device. In analysing situation and designing recommendations, allow for technologies to evolve with time. Place more emphasis on appropriateness of technology as a concept, noting that "appropriate technology" may not be a favoured term due to associations with cheapness and low quality. Dismiss the idea that there is some special technology that is perfect for people with disabilities in developing countries; in fact, technology already exists, but adequate services do not. Stress long-term needs, e.g. replacement of technologies over a lifetime. Provide statistics on met and unmet needs for assistive technologies. Include more on: o impact of devices on quality of life; o fmancial sustainability of funding for technologies; o strategies for increasing ease of use of technologies; o training users to use devices; o need for appropriate environments to complement use of technology; o information for users and health persormel about available devices; o "brain drain" of service providers; o rehabilitation engineering;
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Au?~entative and Alternative Communication (AAC) - alphabet boards, facIlitated communication, etc.; o orthoses; o listening devices other than hearing aids; o SMS use by deaf people; and o virtual worlds. Recommend research on impact of devices on quality of life. Recommend governments to encourage manufacturing and provision of devices. Encourage manufacturers to be socially responsible. Modify recommendation on local production to be on a case-by-case basis. Most often users need devices that are fit from components manufactured wherever is cheapest, highest quality, and most efficient. Recommend developing countries maximize human resources, e.g. prosthetic and orthotic technicians, to offset limitations in financial and physical resources. Recommend establishing orthopaedic workshops to provide simple devices.
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Chapter 4: Support Services Better define support services. Link with other chapters: enabling environments, assistive technology, and information and communication. Provide a policy-prograrnme-implementation pathway, even for developing countries where support services are a new concept. Clarify possible entry points to systems and services, including role of Disabled People's Organizations (DPOs). Include a box with examples of support services, e.g. personal care, activities of daily living (ADL), interpretation, coaches for people with difficulty learning. Include more on: o support services as facilitators of participation; o demographic characteristics and skill levels of providers of support; o people with disabilities as service providers, including through self-help groups; o unpaid providers of support (family, friends) and related issues; o coordination of support services, e.g. through key workers, service coordinators and case management; o cultural influences on access to support services; o strategies for increasing community awareness and involvement; o support for indigenous people, people with mental health problems, and children with disabilities; o training of service providers - technically and about rights; o training of mainstream staff to support people with disabilities, e.g. car park attendants; o training of people with disabilities to manage support workers; o sustainability of services; o models of service provision beyond CBR and IL; o government-directed support services; and o intergovernmental organizations' support to countries. Recommend giving people with disabilities choices about and control over support services.
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2.1.9
Chapter 5: Enabling Environments Clarify whether the chapter is about accessibility or the broader topic of enabling environments (social, policy, infonnation, etc.). Link with other chapters: employment, education and rehabilitation therapies. Present social inclusion as the paradigm shift, not universal design. Offer pragmatic solutions for policy-makers. Avoid holding up America Disabilities Act (ADA) as the desirable standard. Emphasize enforcement of existing laws and standards. Expand coverage in chapter beyond wheelchair users. Include more on: o costs of accessibility and funding mechanisms o markets for change o sustainable solutions o social capital; role of community in creating inclusive environments o social as well as physical barriers and facilitators o people with disabilities as resources and trainers on accessibility o obligations and education of professionals - architects, etc. o institutions to create and/or implement standards o private enterprises providing accessibility and public-private partnerships o legal approaches o public transportation including air and sea transport o rural accessibility o design for land features o design for the whole lifetime. Recommend development of minimum accessibility standards internationally. Recommend national legislation on accessibility. Recommend providing incentives rather than sanctions-driven systems for enforcement of standards. Make corrections: o Fix inconsistency of treatment of legal basis of design standards in first and second parts of chapter. o Fix incorrect statement that there is no international dialogue about accessibility. o Fix incorrect statement that ramps are conducive for the blind. o Check the accuracy of data on trend towards private vehicles in urban areas. Chapter 6: Infonnation and Communications Infonnation should be moved to the beginning of part 2 as an introduction to the other chapters on participation and inclusion. Infonnation should be part of chapter 4 on support services. If chapter 5 is broadened to encompass all aspects of accessibility, then infonnation could be included as part of that chapter. Link to other chapters: education, health, employment, and assistive technology. Relate the tenns "deaf' and "hearing impaired" to WHO definitions. Emphasize that despite diverse examples of communication strategies, there may be a need to use individual personal communication for complex issues. Include more on: o training of sign language interpreters; o importance of access to sign language interpreters, other than for work and official infonnation; o implications oflack of national unified sign language in some countries;
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o o o o o o o o o o o o o o o o o o o o o o 2.1.11 • • • • • • •
lack of trilingual interpreters who know sign language and a second language, e.g. for use by refugees; oral (lip-reading) interpreters; teaching sign language to the parents of deaf children; training teachers of deaf children to teach a second or subsequent language; communication in native language or preferred language for bilingual people with disabilities; teletypewriters (TTY s); telephone transfer services; SMS communication on cell phones by the deaf; access to information and communication technology; computers enabling employment opportunities; importance of literacy; non-verbal communication; communication for legal processes, including for children with disabilities; training the general public to accept and communicate with people with communication difficulties; distance training packages for parents of children with disabilities; information about disasters for people with disabilities; information about health, e.g. for prevention of secondary conditions; capacity-building, including for the broader society; e.g. training website developers; community service obligation to provide low-cost services; NGOs as major providers of information services; assisting DPOs on information; and inclusion of information and communication in CBR programmes;
Chapter 7: Education and Training Discuss transitions from education to adult roles perhaps in this chapter, or in the chapter on work and employment Link to chapters on assistive technology, employment. Improve relevance across different country contexts, including those where there are very significant basic issues in the educational systems. Emphasize need for schools to have support in identifying children with disabilities and designing appropriate interventions for them. Provide data on numbers of children with disabilities being educated. Provide data on and/or examples of how inclusive education leads to wider employment opportunities. Include more on: o different levels of education - primary, secondary, tertiary; o differences between educational needs for different impairment groups; o special education; o needs of children and teachers in integrated schools; o relationships between communities and schools, and wider contexts of educational services; o strategies for preventing abuse of children in residential education; o good practice models for inclusive education in rural areas; o education systems as means of addressing issues of stigma; o education about disability for non disabled people; o disabled students as role models within schools; o need for early identification and screening, especially for visual and hearing impairments;
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infant and preschool education, especially up to age 3; continuity from eady interventions to educational interventions; training; adult education, especially for those who were unable to receive education as children; and stewardship role of government in the context of extensive use of private education.
Chapter 8: Work and Employment Link to other chapters: education, including transitions to employment; enabling environments, including accessible transportation; and assistive devices. Orient more towards policy-makers. Deal with livelihoods, not just work and employment. Correct inappropriate bias towards formal sector employment, which may not be possible or preferred for people with disabilities in poor countries. Better analyse strategy of quotas, including role of enabling environments. Provide more data on types of employment - public, private and self-employed. Include more on: o what has not worked; o income support; o self- and informal employment; o access to credit; o analysis of sheltered employment; o public sector as a model employer; o different models for public and private interventions and partnerships; o role of government, including tax incentives to employ people with disabilities; o importance of DPOs in development of employment initiatives; o training for employment; o career development for people with disabilities; o employment strategies for people who have been out of work for a long time; o strategies for maintaining employment with a chronic disease; o impact of age-related disabilities on employment; o employment for people with disabilities after disasters and conflicts; o use of role models; o limitations of antidiscrimination laws; o information and support for employers, including from other employers who have successfully employed people with disabilities; o trade unions and organized labour; and o workplace injury. Chapter 9: Justice and Rights Include rights and justice in the introductory chapter (including history of disability as a rights issue), but also have a chapter based on Article 13 of the Convention (Access to Justice). Make chapter more inspiring, stimulating and easy to read. Emphasize Optional Protocol and mechanisms for Convention implementation. Add references to instruments beyond the UN Convention on the Rights of Persons with Disabilities, e.g. Convention on the Rights of the Child. Incorporate the concept of progressive realization of rights; set realistic expectations, goals and benchmarks. Emphasize that equity of access does not necessarily lead to equity of outcomes.
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Focus on economic development as a rights issue. Associate rights with reduction of prejudice or stigma; highlight leprosy and neurological conditions as especially stigmatizing, along with mental health. Emphasize empowerment and self-advocacy for individuals and DPOs. Emphasize the importance of choice. Include more on: o access within the justice system; o legal capacity and informed consent to treatment; o social protection, including as part of CBR; and o enforcement of laws. Check the accuracy of data presented in the chapter. Recommendations for the World Report on Disability and Rehabilitation
The following 100 recommendations for the World Report were proposed by participants at the consultation: (1) Include financing for disability work in main budgetary planning at all levels of government programmes. (2) Modify existing insurance policies and laws or create new ones to include rehabilitation services. (3) Increase education and awareness-raising about disability programmes and services, including creating a directory of where services can be found. (4) Within each country, develop an outcome-based coordinated systems approach, based on the key elements of the Convention, which achieves the goal of full inclusion of people with disabilities in society. (5) Include in the UN Convention monitoring process: monitoring, benchmarking, and exchange of best practices on the World Report at the international, regional, and national levels. (6) Develop mechanisms that enable people with disabilities to have a central role in rehabilitation service delivery, policy, and planning functions within countries. (7) Develop human resources by training professionals on all aspects of disability, including ethical and legal aspects and ICT, rr." and CBR principles. (8) Carry out research in many countries with WHO protocols to create internationally comparable data that will help in national planning processes, on prevalence and types of disabilities, infrastructure, and available successful programmes. (9) Governments should implement universal design, starting with their own buildings and programmes, to provide examples of good practice. (10) As part of the registration of medical practitioners, require compulsory annual training on health care for people with disabilities. (11) National research councils should introduce specific criteria for inclusion ofpeople with disabilities in research. (12) The medical and legal professions should re-examine notions of informed consent and best interest.
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(13) Specific issues of women and girls with disabilities should be identified and addressed.
(14) Special attention should be paid to people with disabilities who are at particular risk.~f suffering from stigma and discrimination, including those with leprosy, neurologIcal condItIOns, and intellectual impairments. (15) Disability surveillance and screening should be promoted through specific at-risk population surveys and disease management programmes, e.g. for diabetes. (16) Health care quality improvement agencies should focus more on access to health care systems, ~cluding physical and communication access, for people with disabilities. (17) Health care for specific population groups including people with disabilities must be monitored in order to ensure equity for all. (18) Remove all tariffs and taxes on goods and services for assistive technologies and creation and maintenance of enabling environments. (19) Government health systems' registration boards should make necessary changes to allow prOvision of services by paraprofessionals. (20) Introduce standard questions related to disability on all government forms. (21) Gear up the public health system for early intervention and prevention of impairments caused by noncommunicable disease. (22) Strengthen trauma management and evacuation networks to avoid post-traumatic impairment that has long-lasting impacts. (23) Undertake training of community workers in order to launch national programmes for early identification, intervention, and awareness on disability. (24) Provide basic educational needs assessments and appropriate placement of all children with disabilities. (25) Develop national and/or state policies or strategies on disability with cross-sectoral input under the lead of a cross-tninisterial agency, with intensive involvement of people with disabilities. (26) Analyse country contexts, policy, and legal environments to understand logical entry points. (27) Make efforts sustainable and possible for the context. (28) Focus on sensitizing the general public about stigma, including by promoting role models with disabilities. (29) A unified tertninology for disability should be developed and adopted worldwide, specifying criteria for different kinds of disability. Otherwise, China should change its tertninology to cover "moderate", "severe" and "mild" disabilities including those caused by cardiopulmonary disorders. (30) More attention should be paid to prevention of disabilities, including by providing better maternal and child care, health education, and prevention of accidents.
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(3.1) Raise awarene~s ~bout t~e shift in disability paradigms for medical to rights-based models Wlt~ empha~ls o.n bUlldmg an mclusive, barrier free, and rights-based society, including in natlOnalleglslatlOn and policies. (32) Accurate and comprehensive census and statistics should be lilldertaken regarding prevalence of disabilities to allow governments to understand and fund the needs of people with disabilities. (33) Create special administrative and training positions in local government structures for local paramedical and allied health providers in order to prevent bnun drain. (34) Review current rehabilitation interventions and make recommendations on applicability of up-to-date evidence-based techniques. (35) Create healthy and healing environments for people with disabilities. (36) Integrate CBR programmes in medical, nursing, and paramedical curricula. (37) Governments should support full implementation of the Magna Carta for people with disabilities. (38) Promote knowledge of ICF concepts for all medical professions and encourage review of government deflnitions of disability. (39) Provide training programmes for regular school teachers on managing education of children with disabilities. (40) Facilitate rehabilitation research and development, especially on assistive technologies. (41) All countries should give people with disabilities legislative protection of their rights. (42) All government policies and programmes should consider people with disabilities as a priority group and should respond to their needs and issues. (43) Shift available resources to support people with disabilities in their own homes and communities rather than in institutions. (44) Conduct a survey on the level of awareness of communities to know what issues need to be raised about disability and plan advocacy campaigns. (45) Designate representatives with disabilities for all national development committees in order to mainstream disability issues into all programmes. (46) Build local capacity of institutions to benefit from and use international tools, e.g. to apply legislation and policies in ways that are consistent with the local context. (47) Develop empowerment models to enable people with disabilities to develop organizations and produce social impacts so that DPOs can become agents of change to promote inclusive, barrier free, and rights-based societies for all. (48) Promote networking and collaboration among inclusive stakeholders in order to maximize, mobilize, and utilize community resources.
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(49) Develop environmental models, especially with regards t~ atti~de~,. i~ order to develop educational tools for health care service providers and people wlth disablhtles. (50) Take a twin track approach (empowerment + mam"streaminglinclusion). (51) Implement disability equality training (DET) on rights and equality. (52) Ensure the security of income and livelihood for people with disabilities. (53) Increase the number of intellectually impaired experts and volunteers. (54) Introduce inclusive education from the earliest age in order to create an inclusive and sustainable society. (55) Collect "best practice" stories from low-income countries. (56) Change the disease-focused model of health care to a biopsychosocial model. Health funding for rehabilitation services should be independent from the acute to the community levels rather than mixing with disease-oriented approach. (57) Governments should take the lead in increasing employment of people with disabilities within government departments, using quotas as well as providing incentives for private employers to employ people with disabilities. (58) Promote education for rehabilitation personnel at all levels. Introduce the medical concept of rehabilitation at the undergraduate level, e.g. for medical students. (59) Disability awareness should be introduced in all types of undergraduate curricula, e.g. not only in medical faculties, but also in law and architecture. (60) Develop or strengthen grassroots DPOs in local advocacy roles. (61) Disability concerns should be included in development planning and policies of all international development organizations regardless of the sector with which they work, in the same way that issues related to women and the environment are included. (62) Promote consumer-driven public models. (63) Update rehabilitation and vocational programmes to make them more desirable to students and promote disability-friendly professional development in the disability field, especially of teclmical personnel. (64) Leaders and policy-makers should be briefed regularly about disability policy, including the Convention, and should concentrate on implementing and updating policies as needed. (65) Establish and strengthen mental health care to include healthy lifestyle, trauma management, substance abuse, and mental illness. (66) Review and improve educational policies and systems for children with disabilities, keeping in mind the goals of independent living, sustainable livelihood, and greater political participation. (67) Include monitoring systems for violation of the rights of people with disabilities and provide legal assistance at the national and local levels.
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(68) Improve education systems by including CBR training as part of teacher education at all levels. (69) Train teachers at all levels about detection of disabilities, classroom management, and methodologies that allow all children to learn. (70) Develop inclusive education programmes progressively, with proper support as needed. (71) Improve work and employment for people with disabilities; support people with disabilities in getting jobs with special training, support their activities financially, assist them in selling their products through developing appropriate marketing. (72) Prevent impairments, including primary prevention of important causes of disability, improving quality of medical care, and early rehabilitation, noting the importance and' high cost-benefit ratio. (73) CBR, including the five components, is the main strategy to bring most needed services to the neediest people with disabilities and their families. This can be done through policies and funding and concerted efforts of experts of all specialties. (74) Enabling environments through universal design will be beneficial to all, not only people with disabilities. (75) Create and use regional as well as national action plans. (76) Encourage private-sector participation in developing cost-effective technologies and devices, providing services, and employing people with disabilities by setting quotas, providing tax incentives and subsidies, appealing to corporate social responsibility, and recognizing good practices where applicable and appropriate, (77) Develop participatory tools to enable advances for people with disabilities to be captured, i.e. measure outcomes in participation across different domains of functioning. (78) Reclassify the world health system to recognize neurological conditions as separate from physical, sensory, intellectual, and mental health. (79) Include disability in all the national MDG plans. (80) Fund technological advances to enable scarce human resources to be shared between developed and developing worlds, e.g. using telemedicine. (81) Governments, NGOs, international organizations, donors, and United Nations bodies should work in partnership with DPOs to strengthen their capacities and to ensure implementation of policies and best-practice programmes. (82) Coordination committees should be established at the national level to ensure effective representation ofDPOs. (83) States parties, donors, international organizations, and NGOs should make resources available to ensure that implementation of these recommendations takes place, including support to encourage regional cooperation. (84) Promote global standardization of terminology and date collection methods on incidence and prevalence of disability.
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(85) Implement policies wherein government agencies work together with NGOs to improve opportunities for better health care, employment, and education and avoid duplication of efforts. (86) Introduce disability and rehabilitation fields into existing community development and poverty alleviation projects. (87) Provide comprehensive annual health checks for people with disabilities delivered by allied health professionals at the local level, to include review and health planning around especially vision, hearing, sexual health, dental health, and other normatives. (88) Introduce schemes for providing safe shelter and emergency services for single women with disabilities over age 45 in need of public assistance for existence. (89) Urgently promote a unified national sign language and deploy interpretation services through conventional modes, the Internet or other appropriate technologies, particularly at health centres, universities, courts, police stations, and other public places. (90) Provide social protection measures for people with disabilities. (91) Women with disabilities should be included in all programmes and services. (92) Create accountability schemes to national committees. (93) Deliberate efforts to increase participation of women, persons with intellectual and psychosocial disabilities, in both mainstream and disability-specific programmes. (94) Consider disability as a cross-cutting issue in all processes of planning, implementation, and evaluation of government programmes. (95) The World Report should serve as an implementation tool for the UN Convention on the Rights of Persons with Disabilities at the country level. (96) Countries should not put the national policy lead for disability in their most pathetic ministry OR put the disability leader/coordinator in the most powerful consolidated ministry. (97) Use the ICF framework to improve quality and consistency of statistics, giving countries flexible guidance and principles to focus on their particular information needs. (98) Move from negative language to neutral and inclusive language. (99) Find another word for disability that doesn't reflect a deficit model. (100) Develop a knowledge management system and/or clearinghouse for disability information. 2.3 • Ideas for launches and other events What: o Hold a "soft" launch before the "hard" launch - both national and global o futeractive activities on the Internet - people can make commitments for action o Relay-style launch worldwide - perhaps with release by fmance ministers, with launches in various countries; post film on the futernet o Collect stories about people with disabilities to give to the media, e.g. about employment, assistive technologies. o Hold a competition of short films or documentaries by people with disabilities
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•
•
•
When: o November 6: Use the Conference of States on the Convention as the launch date to link the report with monitoring in people's minds o December 3: International Day of People with Disabilities Where: 0 ILO annual meeting, World Health Assembly, other United Nations meetings 0 Launch at economic summits rather than or in addition to health meetings Oman 0 0 United States of America 0 Jordan, with Prince Riyadh 0 Akiie Ninomiya, Chief Adviser of the Asia-Pacific Development Center on Disability (APeD) project has offered to help coordinate a regional launch involving multiple stakeholders in Bangkok, but would like to be asked one year ahead. Who: 0 Disabled people's organizations Stay away from "supercrips" 0 0 Champions from developing countries 0 Politicians who have children with disabilities Potential champions or patrons 0 • First Lady of Panama, Queen of Qatar, Jeffrey Sachs, Eunice Shriver, Arnold Schwarzenegger, Julia Roberts, Mark Ingles, David Paterson, Stevie Wonder, children with disabilities who aren't celebrities
3. CONCLUSIONS
3.1
Review of draft chapters of the World Report on Disabilitv and Rehabilitation
Notes taken at the meeting will be collated along with feedback from the three other regional consultations, other reviewers, the Editorial Committee, and the Advisory Committee, and used by the Emtorial Committee to help guide development of the next draft of the report. Participants will be sent specific forms (i.e. blank lists by topic and name of participant) to provide the evidence agreed upon during the consultation, and will be requested to send these to the Department of Violence and Injury Prevention and Disability at WHO Headquarters copied to the appropriate regional office. WHO staff will follow up as necessary to collect as much of this evidence as possible, and relay it to the lead chapter authors as appropriate. 3.2 Recommendations and future steps
The proposed recommendations from all the regional consultations, including this one, will be reviewed by the Emtorial Committee and used to guide development of Chapter 10, Conclusions and Recommendations, when it is written in late 2008. The information provided by consultation participants during the discussion on launches and other events will be used in planning the launch and dissemination strategy.
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ANNEX 1
LIST OF TEMPORARY ADVISERS, REPRESENTATIVES! OBSERVERS~SECRETARIAT
TEMPORARY ADVISERS
Australia
Ms Rosamond Madden Coordinator, ICF Research Development Faculty of Health Sciences University of Sydney Room G114, Cumberland Campus C42 P.O. Box 170 Lidcombe NSW 1825 Australia Telephone: +61-409-767-266 Fax: +61 29351 9540 Email: rosmadden@usyd.edu.au Mr Grant Preston 94 Mt Combe Rd Kulangoor Queensland 4560 Australia Telephone: +61 754468612 Fax: +61 75476 1500 Email: gwPJandina@yahoo.com
Ms Miriam Taylor Research Project Officer QCIDD - Queensland Centre for Intellectual and Developmental Disability University of Queensland School of Medicine Mater Community Services Building Mater Hospital Annerley Road, South Brisbane, Queensland 4101 Australia Telephone: 61-7-31632446 Fax: 61-7-31632445 Email: m.taylor3@uq.edu.au
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Annex 1
Bangladesh
Mr Mohammad Abdus Sattar Dulal Founder and Executive Director Bangladesh Protibandhi Kallyan Somity (BPKS) BPKS Complex, Dhakkhinkhan, Uttara Dhaka - 1230 Bangladesh Telephone: +8802-8923915/8960077 Fax: +8802-8960078 Email: cotoed@bpksbd.org; asdulal@bpksbd.org Dr Mary Scott Country Director Cambodia Trust Calmette Hospital Preah Monivong Boulevard Phnom Penh Cambodia Telephone: +855 23 427 067 /23 426 380 Fax: Email: mscott@cambodiatrust.org.kh Dr Qiu Zhuoying Director Research Institute of Rehabilitation Information China Rehabilitation Research Center No. 10 North Street Fangtai District Beijing 100068 China Telephone: 0086-13910566264 Fax: 008610-67562515 Email: qiutiger@hotmail.com;qiuhongl00@yahoo.com Dr Anuradha Mohit Director National Institute for the Visually Handicapped (NIVH) 116, Rajpur Road Dehradun - 248 001 Uttarakhand India Telephone: 0091-135-2744491 Fax: 0091-135-2748147 Email: anuradhamohit@postmark.net
Cambodia
China
India
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Annex 1
Dr Maya Thomas Editor Asia Pacific Disability Rehabilitation Journal J - 124, Ushas Apartment, 16th main, 4th Block Jayangar Bangalore- 560011, Karnataka India Telephone: +91 8026961556 Fax: Email: thomasmaya@hotmail.com Indonesia Dr Bulantrisna Djelantik President SEAF Sound Hearing ENT Department Medical Faculty UniversitasPadjadjaranlHasan Sadikin Hospital n Pasteur, 38 Bandung 40151 Indonesia Telephone: Fax: Email: btrisna@gmail.com Ms Tumenbayar Batdulam Manager National Program of Community-Based Rehabilitation National Rehabilitation Center P.O. Box 364 lnaanbaatar210620 Mongolia Telephone: +97699040071 Fax: +976 11352423 Email: batdulam5@yahoo.com Ms Anne Hawker Ministry of Social Development Level 2, ENZA House P.O. Box 1556 Wellington New Zealand Telephone: 006449142456 Fax: 00644918 0102 Email: Anne.HawkerOl1@msd.govt.nz
Mongolia
New Zealand
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Annex 1
Philippines
Ms Amy Bolinas Simon of Cyrene Children's Rehabilitation and Development Foundation 286 Banag Daraga, Albay 4501 Philippines Telephone: 63-052-483-4195 Fax: 63-052-483-4195 Email: amybolinasI350@yahoo.com Ms Venus nagan National Project Director Breaking Barriers for Children Unit 701 Merchants Square Condominium 1386 E. Rodriguez Avenue Quezon City 1112 Philippines Telephone: (632) 412-0506 Fax: (632) 411-9655 Email: bbc701@surfshop.net.ph Professor Betty Dy-Mancao Consultant, Community-Based Rehabilitation Department of Rehabilitation Medicine University of the PhilippinesPhilippine General Hospital Taft Avenue Manila 1000 Philippines Telephone: (632) 5264357 Fax: (63 2) 5264357 Email: bettydy@gmail.com
Thailand
Dr Wachara Riewpaiboon Program Manager Health Promotion Program for People with Disability in Thai Society Sirindhorn National Medical Rehabilitation Center Ministry ofPubIic Health Soi Bamrasnaradura Tiwanond Road, Amphur Muang - 11000 Bangkok Thailand Telephone: 6629510830 Mobile: 66 81 8296094 Fax: 6629510830 ext. 11 Email: wachara@health.moph.go.th;wacharaI6@gmail.com
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Annex 1
REPRESENTATIVES/OBSERVERS
Bangladesh Protibandhi Kallyan Somity
Mr Mohammad Jashim Uddin Director Planning, Evaluation, Research and Information Bangladesh Protibandhi Kallyan Somity (BPKS) BPKS Complex, Dhakkhinkhan, Uttara Dhaka - 1230 Bangladesh Telephone: +8802-8923915/8960077 Fax: +8802-8960078 Email: Mr Michael Davies Regional Director CBM South-East Asia and Pacific Unit 604, Alabang Business Tower 1216 Acacia Avenue Madrigal Business Park Alabang Muntinlupa City 1780 Philippines Telephone: Fax: Email: matabele@pldtdsLnet Dr Leonard S.W. Li Consultant Physician (Rehabilitation Medicine) Tung Wah Hospital and MacLehose Medical Rehabilitation Centre Member, Advisory Committee The Hong Kong Society for Rehabilitation WHO Collaborating Centre for Rehabilitation 5/F, 7 Sha Wan Drive Pokfulam Hong Kong Special Administrative Region China Telephone: 852-2589-8575 Fax: 852-2858-7340 Email: lswli@hkucc.hku.hk
CBM South-East Asia and Pacific
The Hong Kong Society for Rehabilitation
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Annex 1
Japan International Cooperation Agency
Dr Yoko Isobe Technical Support Staff Social Security Team Human Development Department Japan International Cooperation Agency Shinjuku Maynds Tower Bldg., 8F 2-1-1, Yoyogi, Shibuya-ku Tokyo 151-8558 Japan Telephone: 81-3-5352-5442 Fax: 81-3-5352-5320 Email: jicahm-disability@jica.go.jp Dr Kenji Kuno Chief Adviser Project for Persons with Disabilities in Malaysia Department of Social Welfare Ministry of Women, Family and Community Development Tingkat 19, Menara Tun Ismail Mohamed Ali Jalan Raja Laut, 50562 Kuala Lumpur Malaysia Telephone: 03-26165669; 016-619-6394 Fax: 03-26917473 Email: kenjUruno@yahoo.coJp Mr Akiie Ninomiya Chief Adviser of APCD Project Asia-Pacific Development Center on Disability 255 Rajvithi Road Rajthevi Bangkok 1040 Thailand Telephone: Fax: Email: ninomiya@apcdproject.org Ms Noriko Saito Chief Advisor of the Creation of Non-handicapping Environment Project National Council on Disability Affairs Office of the President of the Philippines Ground Floor Sugar Regulatory Administration Building North Avenue, Diliman Quezon City 1100 Philippines Telephone: +63 (0)9204411 836; +63 (0)2 920 1503 Fax: +63 (0)2920 1503 Email: nonchandct@gmail.com
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Annex 1
Ministry of Health, New Zealand
Ms Kylie Clode Disability Policy Manager Population Health Directorate Ministry of Health P.O. Box 5013 Wellington New Zealand Telephone: 04 4962329 Fax: 04 496 2050 Email: kylie_clode@moh.govt.nz Dr Geetika Mathur Senior Medical Officer National Institute for the Visually Handicapped (NIVH) 116, Rajpur Road Dehradun - 248001 Uttarakhand India Telephone: 0091-135-2744491 Fax: 0091-135-2748147 Email: Dr FumioEto Director of the Training Center National Rehabilitation Center for Persons with Disabilities WHO Collaborating Centre for Disability Prevention and Rehabilitation 4-1 Namiki Tokorozawa City Saitama 359-8555 Japan Telephone: (81-42) 9953100 Fax: (81-42) 995 3661 Email: f-etou@rehab.go.jp;whoclbc@rehab.go.jp
National Institute for the Visually Handicapped
National Rehabilitation Center for Persons with Disabilities
Negros Occidental Rehabilitation Foundation, Inc.
Dr Filipinas G. Ganchoon Medical Officer and Director Negros Occidental Rehabilitation Foundation, Inc. WHO Collaborating Centre for Rehabilitation Comer Cottage Road and Lacson Street Bacolod City 6100 Philippines Telephone: (034) 435-3794/ (034) 709-7887 Mobile: 09209271250 Fax: (034) 433·5767 Email: fllipinasmd@yahoo.com
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Annex 1
Dr John Andrew B. Sanchez Medical Officer and Director Negros Occidental Rehabilitation Foundation, Inc. WHO Collaborating Centre for Rehabilitation Comer Cottage Road and Lacson Street Bacolod City 6100 Philippines Telephone: (034) 435-3794; (034) 709-7887 Mobile: 09757855957 Fax: (034) 433-5767 Email: druxI6@yahoo.com Sun Yat-Sen University of Medical Sciences Professor Zhuo Dahong Head Department of Rehabilitation Medicine Sun Yat-Sen University of Medical Sciences WHO Collaborating Centre for Rehabilitation 58 Zhongshan Road 2 Guangzhou 510080 China Telephone: +86(20)87330193 Fax: +86(20)87331679 Email: dhzhuo@Gmail.com Professor Huang Xiaolin Department of Rehabilitation Medicine Tongji Hospital Tongji Medical College WHO Collaborating Centre for Rehabilitation 1095 Jiefang Dadao Wuhan 430030 Hubei China Telephone: 86-27-83663347 Fax: 86-27-8364-8310 Email: Xiaolinh2006@yahoo.com.cn Ms Susan E. Hirshberg South Asia Regional Disability Coordinator and Senior Education Specialist The World Bank 1818 H Street, NW Washington, D.C. 20433 United States of America Telephone: (1-202) 458-1953 Fax: (1-202) 522-3304 Email: Shirshberg@worldbank.org
Tongji Medical College
The World Bank
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Annex 1
Dr Emmanuel Y. Jimenez Director, Human Development East Asia and Pacific Region The World Bank 1818 H Street, NW Washington, D.C. 20433 United States of America Telephone: (1-202) 473-3481 Fax: (1-202) 522-0056 Email: Ejimenez2@worldbank.org Ms Charlotte McClain-Nhlapo Senior Operations Officer Regional Disability Coordinator for Africa and for South Asia The World Bank 1818 H Street, NW Washington, D.C. 20433 United States of America Telephone: (1-202) 458-5680 Fax: (1-202) 522-3394 Email: cmcclainnblapo@worldbank.org Dr Philip B. O'Keefe Lead Social Protection Specialist The World Bank: New Delhi India Telephone: Mobile: 91-98-11-846-037 Fax: Email: Pokeefe@worldbank.org
Dr Sandor Sipos Sector Manager Social Protection and Labour Human Development Network The World Bank 1818 H Street, NW Washington, D.C. 20433 United States of America Telephone: (1-202) 473-1147 Fax: (1-202) 522-3252 Email: Ssipos@worldbank.org
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Annex 1
Ms Catherine Sykes Consultant to the World Bank 12 W oolls Street Yarralumla ACT 2600 Australia Telephone: +61262854728
Fax:Email: c.sykes@netspeed.com.au
SECRETARIAT
Dr Hisashi Ogawa Regional Adviser Healthy Settings and Environment World Health Organization Regional Office for the Western Pacific United Nations Avenue P.O. Box 2932 United Nations Avenue 1000 Manila Philippines Telephone: (632) 528-8001 Fax: (632) 521-1036 E-mail: ogawahi@wpro.who.int Ms Alana Officer Coordinator Disability and Rehabilitation Department of Violence and Injury Prevention and Disability World Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland Telephone: +41227912977 Fax: +41 22791 4874 Email: officera@who.int
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Annex 1
Dr Chamaiparu Santikarn Regional Adviser Disability, Injury Prevention and Rehabilitation W orId Health Organization South-East Asia Regional Office Indraprastha Estate Mahatma Gandhi Marg New Delhi-l 10002 India Telephone: 23370804 ext. 26519 Fax: (91)-11-23379507; 23370197; 23379395 Email: santikaruc@searo.who.int Ms Bliss Temple Technical Assistant Disability and Rehabilitation Department of Violence and Injury Prevention and Disability W orId Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland Telephone: +41227912977 Fax: +41 227914874 Email: templeb@who.int
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ANNEX 2
PROGRAMME OF THE CONSULTATION
24 June 2008 0800-0830 0830-0900 Registration Opening speech by Dr R. Nesbit, Director, Programme Management on behalf of the WHO Regional Director for the Western Pacific Opening remarks by Dr E. Jimenez, Director, Human Development, World Bank East Asia and Pacific Region Self-introduction of participants Selection of meeting chairs
Administrative announcements (Dr H. Ogawa) 0900-0930 0930-1000
Group photograph and Tea/Coffee break Adoption of agenda and programme (Dr H. Ogawa)
Briefing on background, purpose and expected outcome (Ms B. Temple) Brief overview of chapters (Dr S. Sipos) 1000-1100 1100-1200 1200-1300 1300-1400 Chapter 1: Introduction - Discussion and recommendations (Ms R. Madden) Chapter 7: Education and Training (Ms S. Hirshberg) Lunch break Chapter 2a: A Global Picture - Discussion and recommendations (Ms R. Madden) Group I (Dr C. Santikarn/Ms A. Officer) 1400-1500 Chapter 3c: Assistive TechnologiesDiscussion and recommendations (Ms B. Temple) Tea/Coffee break Chapter 6: Information and Co=unication - Discussion and reco=endations (Ms R. Madden) Chapter 8: Work and EmploymentDiscussion and recommendations (Dr S. Sipos) Group II (Dr H. OgawaJDr S. Sipos) Chapter 5: Enabling EnvironmentsDiscussion and recommendations (Dr Qiu Zhuoying)
1500-1530 1530-1630
1630-1700
Report back from the working groups by nominated rapporteurs
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Annex 2
25 June 2008 0830-0930 Chapter 9: Justice and Rights - Discussion and recommendations (Ms V. nagan) Group I (Dr C. SantikarnlMs A. Officer) 0930-1030 Chapter 2b: Impairment Prevention Discussion and recommendations (Ms A. Officer) Tea/Coffee break Chapter 3a: Medical Care and Health Chapter 4: Support ServicesSystems - Discussion and recommendations Discussion and recommendations (Ms M. Taylor) (Dr M. Thomas) Report back from the working groups by nominated rapporteurs Lunch break Brief introduction to recommendation chapter (Ms A. Officer) What recommendations should be put forward for inclusion in the frnal chapter? Tea/Coffee break Timeline, launch and next steps (Ms A. Officer) Plans for launches and other events (Ms A. Officer) Wrap up of Day 2 and closing (Dr C. Santikarn, Dr H. Ogawa, Dr S. Sipos and Ms A. Officer) Group II (Dr H. Ogawa/Dr S. Sipos) Chapter 3b: Rehabilitation and TherapiesDiscussion and recommendations (Ms C. Sykes)
1030-1100 1100-1200
1200-1230 1230-1330 1330-1345 1345-1530 1530-1600 1600-1615 1615-1645 1645-1715
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ANNEX 3
LIST OF DOCUMENTS
WPRJ2008IDHP/1OIHSE(2)/2008/IB/1 WPRJ2008IDHP/IOIHSE(2)/2008/IB/2
- Information Bulletin - Provisional List of Temporary Advisers,
Representatives/Observers and Secretariat WPRJ2008IDHP/1OIHSE(2)/2008.la WPRJ2008IDHP/IOIHSE(2)/2008.1b WPRJ2008IDHP/1OIHSE(2)12008.2 - Tentative Agenda - Tentative Programme of Activities - Briefmg on Background, Purpose and Expected Outcome
by Ms Bliss Temple, WHOIHQ WPRJ2008IDHP/]OIHSE(2)/2008.3 - Timeline, Launch and Next Steps
by Ms Alana Officer, WHOIHQ WPRJ2008IDHP/1OIHSE(2)/2008.4 WPRl2008/DHP/lOIHSE(2)2008/JNF.ll - Draft World Report on Disability and Rehabilitation - Presentation Handouts
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ANNEX 4
OPENING SPEECH BY THE DIRECTOR, PROGRAMME MANAGEMENT ON BEHALF OF THE WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC AT THE ASIA-PACIFIC CONSULTATION ON THE WORLD REPORT ON DISABILITY AND REHABILITATION, MANILA, PHILIPPINES, 24 - 25 JUNE 2008
Dr Emmanuel Jimenez, Director, Human Development World Bank East Asia and Pacific Region DISTINGUISHED GUESTS, LADIES AND GENTLEMEN I welcome you to the opening of the Asia-Pacific Consultation on the World Report on Disability and Rehabilitation. An estimated 10% of the world's popUlation, or approximately 650 million people, experience some form of disability. The most common disabilities are associated with chronic conditions, such as cardiovascular and chronic respiratory diseases, cancer and diabetes; inj uries such as those caused by traffic accidents, falls, landmines and violence; mental illness; malnutrition; and HN/AIDS and other infectious diseases. The number of people with disabilities is growing. As such, demand for health and rehabilitation services is also growing. Furthermore, the lives of people with disabilities are made more difficult by the way our society interprets and reacts to disability. There is a need for environmental and attitudinal changes. Despite the magnitude, disabilities are not fully understood by the public. There is no agreement on its defmition and little internationally comparable information on the incidence, distribution and trends of disability or impairments. Despite the significant changes over the past two decades, there is no global document that compiles and analyses the way countries have developed policies and responses to address the needs of people with disabilities. The World Health Assembly in May 2005 deliberated on the issues of disability and rehabilitation. It requested WHO to produce a World Report on Disability and Rehabilitation, based on the best available scientific evidence, to help shape government policies to enhance the lives of people with disabilities. The W orId Report will provide recommendations for action at national and international levels. WHO and the World Bank will jointly produce the report in collaboration with institutions that are already involved in disability and rehabilitation. These partners, with their enormous teclmical and political weight, will ensure the best quality of information and the widest possible dissemination. A draft report has been prepared. It is being reviewed through a series of regional consultations, such as this one, which is for the WHO Regions of South-East Asia and the Western Pacific. The report will be launched in 2009.
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Annex 4
In this consultation, you will discuss and comment on the draft chapters of the report; provide additional data and information from countries in the regions; discuss plans for the launch ofthe report; and discuss ways to implement its recommendations at the regional and country levels. You have two full days of work ahead of you. I hope that you will have fruitful discussions and an enjoyable stay in Manila. I now declare this consultation open. Thank you.