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Accessibility for All: Good practices of accessibility in Asia and the Pacific to promote disability-inclusive development

AKIYAMA, Aiko
HOLLIS, Jake
KRETZSCHMAR, Tyler
December 2016

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"This publication seeks to support policymakers in promoting accessibility at a policy and practical level. It contains information on relevant global and regional mandates that support and promote disability-inclusive development and accessibility, with a view to demonstrate the multi-faceted value of focusing on disability and accessibility policies to achieve broader development goals. Readers will learn about the core concepts of disability and accessibility, and be empowered with knowledge on standards, tools and means of promoting accessibility. Furthermore, this publication will outline and analyse examples of good practices of accessibility identified in Asia and the Pacific. The majority of the good practices featured in this publication were initially discussed at two international and multi-stakeholder workshops that took place in 2014 and 2015, with a few additional examples drawn from Pacific island member States. The selection of practices for this publication is based on their embodiment of the principles of accessibility, demonstrated success, measurable impact on the community, and their adaptable and replicable nature"

World Social Science Report 2016 | Challenging Inequalities: Pathways to a Just World

LEACH Melissa
GAVENTA, John
JUSTINO, Patricia
DENIS, Mathieu
November 2016

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Inequalities are multi-dimensional, multi-layered and cumulative. The Report makes clear that understanding and acting effectively upon inequalities requires looking beyond income and wealth disparities to capture their political, environmental, social, cultural, spatial, and knowledge features. Untangling such complexity is a challenge we must fully take on – if we are to develop policies and solutions that are feasible and sustainable.

 

The Report also emphasizes that the costs of inequalities are very high and borne by all – not just by the deprived and the excluded, but collectively, by current and future generations, in the form of heightened conflict and instability, economic and fiscal losses, environmental degradation, and political tensions. Reducing inequalities is thus everyone’s concern.

 

Countering inequalities requires robust knowledge – but knowledge alone is not enough. The challenge is to improve the connection between what we know and how we act: to mobilize the knowledge of the social and human sciences to inform policies, underpin decisions and enable wise and transparent management of the shift towards more equitable and inclusive societies. In this sense, investment in knowledge is a down-payment for informed change.

 

And in some respects, even the knowledge we have is not fully adequate. Social science research agendas equally require revisiting. The Report calls for a step change towards a research agenda that is interdisciplinary, multiscale and globally inclusive, creating pathways for transformative knowledge.

Exploring the Complexities of Leprosy-related Stigma and the Potential of a Socio-economic Intervention in a Public Health Context in Indonesia

DADUN, Dadun
PETERS, Ruth
LUSLI, Mimi
MIRANDA-GALARZA, Beatriz
VAN BRAKEL, Wim
ZWEEKHORST, Marjolein
DAMAYANTI, Rita
IRWANTO, Irwanto
BUNDERS, Joske
2016

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Purpose: This article explores the complexities of leprosy-related stigma and the potential effectiveness of a socio-economic intervention in Cirebon District, Indonesia.

 

Methods: A qualitative approach was adopted. 53 people affected by leprosy were interviewed, and 17 focus group discussions were conducted among people affected by leprosy, community and religious leaders, and health providers and other key persons who were all purposively selected.

 

Results:  People affected by leprosy face major socio-economic consequences. This was confirmed by key persons. Several opportunities for a possible socio-economic intervention were perceived, as also the barriers. People affected by leprosy are constrained by certain aspects of the health system (e.g., the health providers’ negative attitudes), views in society (e.g., misunderstandings about the condition, stigma), and the physical and social consequences of the disease (impairments, feelings of shame). Study participants identified strategies to deal with these barriers, as well as specific activities for a socio-economic intervention; in particular, the training of staff responsible for implementation.

 

Conclusion and Implications: Socio-economic interventions in the field of leprosy need to anticipate the barriers and develop strategies to deal with them. Cooperation between people working in the health system and those in the welfare / financial system is needed, to improve the quality of life of people affected by leprosy

An Online Survey on Identification of Evaluation Capacity, Needs and Current Practice of Programme Evaluation in Community-based Rehabilitation

WEBER, Joerg
POLACK, Sarah
HARTLEY, Sally
2016

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Purpose: Evaluation of Community-based Rehabilitation (CBR) is important for developing good practice and providing a foundation for evidence of efficacy of practice. Since not much is known about the extent to which monitoring and evaluation (M&E) are carried out within CBR programmes, this study aimed to enhance knowledge by focussing on current M&E activities, the need and capacity of programmes to conduct evaluations and the challenges experienced. 

 

Method: An online survey of 15 questions was developed, field-tested and sent out to 236 CBR managers in Africa, Asia and Latin America.  

 

Results: The majority (86%) of the respondents indicated that their programmes had been evaluated in the past.While this was mainly done by international donors (87%), only around half of the respondents reported programme participants as the main audience. Just over half of the programmes (54%) included people with disabilities, their families and community members in evaluation processes. Insufficient financial resources were considered the most important challenge to conduct evaluation, particularly in the African region and among smaller programmes. The complexity of CBR was also indicated as an important barrier to evaluation.

 

Conclusions and Recommendations:  Although evaluations have been widely implemented in CBR programmes, many of them are not locally owned, and people with disabilities and their families are often not included in evaluation processes. The issues of limited financial resources and CBR complexity reflect current discussions in other areas of mainstream development. It is therefore recommended that models for evaluation in CBR should learn from, and be embedded in, ongoing developments in mainstream evaluation in international developm

Ethical and methodological issues in research with Sami experiencing disability

MELBØE, Line
HANSEN, Ketil Lenert
JOHNSEN, Bjørn-Eirik
FEDREHEIM, Gunn Elin
DINESEN, Tone
Minde, Gunn-Tove
RUSTAD, Marit
2016

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Background. A study of disability among the indigenous Sami people in Norway presented a number of ethical and methodological challenges rarely addressed in the literature.

 

Objectives. The main study was designed to examine and understand the everyday life, transitions between life stages and democratic participation of Norwegian Sami people experiencing disability. Hence, the purpose of this article is to increase the understanding of possible ethical and methodological issues in research within this field. The article describes and discusses ethical and methodological issues that arose when conducting our study and identifies some strategies for addressing issues like these.

 

Methods. The ethical and methodological issues addressed in the article are based on a qualitative study among indigenous Norwegian Sami people experiencing disability. The data in this study were collected through 31 semi-structured in-depth interviews with altogether 24 Sami people experiencing disability and 13 next of kin of Sami people experiencing disability (8 mothers, 2 fathers, 2 sister and 1 guardian). Findings and discussion. The researchers identified 4 main areas of ethical and methodological issues. We present these issues chronologically as they emerged in the research process: 1) concept of knowledge when designing the study, 2) gaining access, 3) data collection and 4) analysis and accountability.

 

Conclusion. The knowledge generated from this study has the potential to benefit future health research, specifically of Norwegian Sami people experiencing disability, as well as health research concerning indigenous people in general, providing scientific-based insight into important ethical and methodological issues in research with indigenous people experiencing disability.

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation

NOBEN, Cindy
EVERS, Silvia
VAN GENABEEK, Joost
NIJHUIS, Frans
DE RIJK, Angelique
2016

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Purpose 

The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. 

 

Methods 

Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. 

 

Results 

Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability −0.51; QALY −0.01).

 

Conclusions 

The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive “e-health” technologies.

AuthorAid

AUTHORAID
December 2015

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AuthorAid is a tool to help researchers in developing countries to network and further disseminate their work to a wider audience. The website contains links to find mentors/collaborators, a range of E-learning opportunities, funding opportunities for people working in developing countries, and a plethora of resources on topics ranging from how to write a grant proposal though to the publication process itself

Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries

O’Dowd, Jessica
MacLachlan, Malcolm
Khasnabis, Chapal
Geiser, Priscille
2015

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Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers.

 

Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting.

 

Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families.

 

Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms.

Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.

Knowledge of Primary School Teachers in Identifying Children with Learning Disabilities

Shari, M
Vranda, Mysore Narasimha
2015

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Purpose: This study explores the knowledge of primary school teachers inidentifying children with learning disabilities.

 

Method: The study sample consisted of 200 primary school teachers from 16 schools in Bangalore, India. The teachers’ knowledge about learning disabilities was assessed using Knowledge Questionnaire on Learning Disabilities.

 

Results: The results revealed statistically significant differences in overall knowledge and various domains across gender, type of school, education, class being taught and years of experience.

 

Conclusion: The need to improve the knowledge of primary school teachers for the identification of children with learning disabilities was highlighted. Based on the findings of the study, the “Manual for Primary School Teachers on Learning Disabilities” was developed.

Virtual Reality Games as an Intervention for Children: A Pilot Study

Muneer, Reema
Saxena, Tanushree
Karanth, Prathibha
2015

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Purpose: This pilot study explored the use of virtual reality-based games as an enjoyable yet effective intervention to improve skills in children with developmental disabilities. Although the intervention was primarily targeted at the enhancement of motor skills, the children’s communication, cognitive and social/emotional skills were also monitored and changes, if any, were tracked during this period.

 

Methods: Therapists guided 5 children (4 boys with Autism Spectrum Disorder and 1 girl with Learning Disability) while they played carefully chosen games on the Xbox-Kinect, in individual sessions. Each child attended between 4 and 6 sessions over a span of one month. Therapists used a 4-point rating scale to evaluate specific skills in each of the four domains (motor, communication, cognitive and social/emotional) at the beginning of the intervention, and again at the end.

 

Results: Pre-and post-intervention scores revealed that the children made significant progress, not only in certain motor skills but also in skills from the cognitive and social/emotional domains. None of the children regressed in any of the skills monitored from the different domains.

 

Conclusions: Initial findings indicate that virtual reality games provide a useful platform for building interventions for children with developmental disabilities. There is much scope for future research in this area. The results of the study provide insights into the skills which might require prolonged, consistent inputs during the intervention, and the ones which might be acquired quickly through leaps in learning. The different ways in which children with varied developmental profiles might benefit from virtual reality-based interventions were also highlighted.

Understanding the interaction of competence standards and reasonable adjustments

HEWLETT, Katherine
NIGHTINGALE, Christine
STEVENS, Tony
July 2015

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“Higher education institutions (HEIs) have responsibility for developing non-discriminatory competence standards, and designing a study programme to address these competence standards. HEIs also have the responsibility to ensure that assessment methods address the competence standards. Adjustments to ways that competence standards are assessed may be required so that disabled students are not put at a disadvantage in demonstrating their achievement. This guidance aims to support HEIs meet these institutional and legal responsibilities, and promote disability equality” by providing information and examples on key areas. The guidance will be of use to all staff involved in developing and assessing competence standards

Exploring a Model of Effectual Learning for a Student Speech Pathology Placement at a Community-Based Rehabilitation (CBR) Centre in Malaysia

VAN DORT, S
WILSON, L
COYLE, J
2014

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Purpose: Speech-language pathologists in Malaysia typically do not work within CBR. Therefore, exploring the use of services through a non-traditional student placement was a crucial first step in understanding how to develop capacity for such services. It was also important to develop an understanding of the ways in which the implementation of this student placement influenced learning in the context of a Malaysian CBR programme.

 

Method: An action research study was designed to implement and evaluate student speech-language pathology (SLP) placement within a Malaysian community-based rehabilitation (CBR) centre for children with communication disabilities. Data collection involved the learning experiences of key adult stakeholders (students, workers, parents, and the principal research investigator (PI) or lead author).

 

Results: Study findings indicated that all adult learners became better empowered by working together. Workers involved in impairment-focussed rehabilitation activities grew in understanding and skills when supported by relevant professionals.The importance of mentoring as a learning-teaching relationship was demonstrated.

 

Conclusion: While the study has indicated that the setting is beneficial as a student placement, the development of a specialisation in CBR for allied health professionals would be a relevant way forward in the Malaysian context.

Knowledge and Beliefs about Ear and Hearing Health among Mothers of Young Children in a Rural Community in South India

NARAYANSAMY, M
RAMKUMA, V
NAGARAJAN, R
2014

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Purpose: To study the knowledge and beliefs about ear and hearing healthcare among mothers from a rural community.

 

Method: In 1 week, 6 focus group discussions were conducted across 6 villages of a district in Tamil Nadu in southern India. The participants were 60 mothers who had children below 5 years of age.

 

Results: Mothers in this rural community had information about some aspects of ear and hearing healthcare. They were aware that use of hairpins and safety- pins to clean ears was harmful; they were knowledgeable about ways to identify hearing ability (child responds to name call, verbal instructions, and startles at loud sounds); and, conditions like consanguinity and malnutrition of expectant mothers were recognised as risk factors for hearing loss. However, misconceptions also existed. The practice of pouring herbal juices to remove insects in the ear continued; there was the perception that all children with a hearing problem were “deaf”, and a lack of awareness about the possibility of partial/unilateral hearing loss. Regarding the age of identification, mothers believed that a child’s ability to speak and the ability to hear was pertinent to assess hearing. None of the mothers related normal speech development to normal hearing.

 

Conclusion: For the success of a community-based hearing screening programme, it is important to utilise the existing knowledge of the mothers, and simultaneously attempt to fill in gaps in knowledge and clarify misconceptions. These measures will facilitate greater compliance from the community in achieving the goals of early identification and early intervention for problems of hearing loss.

Knowledge Management-based Classification Method for Disability-Inclusive Business

SANO, R
CHANDARASUPSANG, T
2014

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Purpose: This study provides evidence to clarify disability inclusiveness in activities of rural business. As an alternative to the analysis method that deals with disability-inclusiveness as a vague concept, knowledge management principles were applied to propose a classification method for disability-inclusive business as an emerging concept at the community level.

 

Methods: The analysis focuses on: 1) productivity of entrepreneurs with disabilities; 2) knowledge of entrepreneurs with disabilities; and 3) understanding of customers. A total of 50 entrepreneurs with disabilities in micro and small businesses in Southeast Asia were identified in this context. Data were collected and analysed according to a story-based knowledge management approach and value chain analysis. Fuzzy logic analysis which exploited domain ontology was utilised to convert knowledge from tacit to explicit, in line with knowledge management principles. A numeric weight based on linguistic variables became available to describe each disability-inclusive business case, as well as the arrangements of fuzzy sets.

 

Results: Out of 50 cases, 7 were classified as fully disability-inclusive while 14 were classified as not disability-inclusive. Productivity of entrepreneurs with disabilities in 3 elements of the value chain, namely procurement, product/service development and distribution, was observed to be significant. The Study showed that disability-related knowledge of entrepreneurs with disabilities could contribute to business performance according to the key success factors to enhance added value. Two elements of the value chain, namely sales/marketing and customer service, are not the decisive factors to define and clarify disability-inclusiveness. 

 

Conclusion: Settings in Southeast Asia are diverse and at varying stages of economic and social development; hence the environment which promotes the disability-inclusive business concept may be inconsistent. Micro and small- scale rural businesses were tackled as a first step to evaluate comparative efforts of each case of disability-inclusive business from the viewpoint of entrepreneurs with disabilities. Therefore, in highlighting the differences, it is recommended that further research should seek to apply weighting factors depending on the individual size, contents and scale of major business areas.

Fatigue and Functional Capacity in Persons with Post-Polio Syndrome: Short-term Effects of Exercise and Lifestyle Modification Compared to Lifestyle Modification Alone

SHARMA, S S
SHETH, M S
VYAS, N J
2014

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Purpose: Post-polio Syndrome (PPS) affects polio survivors many years after the initial attack, and causes new musculoskeletal symptoms and decline in physical function. This study aims to compare the effect of exercise and lifestyle modification versus lifestyle modification alone, on fatigue and functional capacity in persons with PPS.

 

Method: An experimental study was conducted at the physiotherapy department of VS Hospital in Ahmedabad. As per the criteria of Halstead (1985), 21 PPS subjects who were between 18 and 65 years of age, and able to walk indoors and outdoors, with or without assistive aids, were included. They were randomly allocated into 3 groups using the envelope method. Those with physician- diagnosed respiratory or cardiac insufficiency, disabling co-morbidity which interfered with the intervention programme or influenced the outcome, and those unable to cooperate due to cognitive impairment or use of any psychotropic drugs, were excluded. Fatigue and functional capacity were measured using Fatigue Severity Scale (FSS) and 2-minute walk distance, respectively. Physical and psychological functions were assessed using Patient Reported Outcome Measurement Information System (PROMIS) questionnaire and Patient Health Questionnaire (PHQ-9) respectively. Intervention was given for 5 days a week, over 4 weeks. Group A received exercise and lifestyle modification, group B received lifestyle modification alone and group C continued their usual routine for 1 month.

 

Results: There was a significant difference in fatigue and functional capacity within groups A and B, with group A showing better reduction in fatigue than groups B or C. Physical function improved only within group A, and a significant difference was seen compared to groups B and C. Psychological function showed no difference within or between the groups.

 

Conclusion: There was improvement in fatigue, functional capacity and physical function in PPS subjects after 4 weeks of exercise and lifestyle modification. Lifestyle modifications alone for 4 weeks improved fatigue and functional capacity in PPS subjects. There is significant reduction in fatigue and improvement in functional capacity when lifestyle modification advice is given along with exercise.

A world that counts : mobilising the data revolution for sustainable development

UNITED NATIONS (UN) INDEPENDENT EXPERT ADVISORY GROUP ON A DATA REVOLUTION FOR SUSTAINABLE DEVELOPMENT (IEAG)
November 2014

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This report highlights two big global challenges for the current state of data: whole groups of people are not being counted and important aspects of people’s lives and environmental conditions are still not measured; and there are huge and growing inequalities in access to data and information, and in the ability to use it. The report makes specific recommendations on how to address these challenges, calling for a UN-led effort to mobilise the data revolution for sustainable development: fostering and promoting innovation to fill data gaps; mobilising resources to overcome inequalities between developed and developing countries and between data-poor and data-rich people; leadership and coordination to enable the data revolution to play its full role in the realisation of sustainable development

Knowledge of, beliefs about and attitudes to disability: implications for health professionals

MASASA, T
IRWIN-CARRUTHERS, S
FAURE, M
2014

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Background: South Africa is a multicultural, multiracial and multilingual nation with many different values, traditions and cultural practices. Different belief systems may give rise to different attitudes and practices relating to disability, which may impact on rehabilitation. The purpose of this study was to investigate the knowledge, attitudes and beliefs relating to disability in three broad cultural groups in the Western Cape.

 

Method: Sixty primary caregivers were interviewed by using a knowledge, attitude and belief (KAB) survey in a structured interview format. Probability and non-probability (systematic and purposive) sampling were used. The study used both quantitative and qualitative methods.

 

Results: While caregivers from coloured and white communities generally had become acquainted with disability from an early age, caregivers in black communities often only learnt about disability following the birth of a disabled child. All caregivers had only a rather rudimentary knowledge of the causes of disability, but held positive attitudes towards people with disabilities and their integration into society. The qualitative data showed some differences in beliefs between the three groups in relation to the causes of disability and the need for rehabilitation. The data also revealed negative experiences across the groups in relation to education and the availability of transport, particularly amongst caregivers from black and coloured communities.

 

Conclusions: Health professionals need to understand the culture, values, beliefs and expectations of their clients when providing rehabilitation services within a community-based model. There appears to be a need for improved disability awareness in schools and amongst transport service providers.

Development process in Africa: Poverty, politics and indigenous knowledge

EIDE, Arne H
KHUPE, Watson
MANNAN, Hasheem
2014

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Background: Persons with disability run the danger of not profiting from the development process due to exclusion from basic services and opportunities. Still, the knowledge base on exclusion mechanisms is relatively weak and there is a danger that important aspects are not addressed as they are hidden behind established understandings that are not critically scrutinised.

 

Objectives: The main purpose of this article was to highlight critical thoughts on prevailing knowledge of the relationship between disability and poverty, the policy base for addressing the rights of persons with disability, and culture as a key component in continued discrimination.

 

Method: This article aimed at integrating three papers on the above topics presented at the 2011 African Network for Evidence-to-Action on Disability (AfriNEAD) Symposium. The researchers have therefore thoroughly examined and questioned the relationship between disability and poverty, the influence of policy on action, and the role of culture in reproducing injustice.

 

Results: The article firstly claims that there are limitations in current data collection practice with regards to analysing the relationship between poverty and disability. Secondly, ambitions regarding inclusion of persons with disability in policy processes as well as in implementation of policies are not necessarily implemented in an optimal way. Thirdly, negative aspects of culture in discrimination and bad treatment of disabled need to be highlighted to balance the discussion on disability and culture.

 

Conclusion: A critical view of prevailing understandings of disability and development is key to producing the knowledge necessary to eradicate poverty amongst persons with disability and other vulnerable groups. Not only do we need research that is actually designed to reveal the mechanisms behind the disability–poverty relationship, we need research that is less tied up with broad political agreements that is not necessarily reflecting the realities at ground level.

Mapping report of physical rehabilitation services in Afghanistan, Bangladesh, Odisha (India) and Sri Lanka

AXELSSON, Charlotte
2014

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This report presents a mapping (situational analysis) of the physical rehabilitation sector in the three countries and the Odisha state in India completed as part of Handicap International’s three year regional program in South Asia “Towards Disability Inclusive Development through a Strengthened Rehabilitation Sector in South Asia”. The aim of this mapping is improve the availability of information on the physical rehabilitation sector and to have an overview of the needs and unmet needs for physical rehabilitation

The Convention on the Rights of Persons with Disabilities Training Guide : Professional Training Series No. 19

UNITED NATIONS HUMAN RIGHTS OFFICE OF THE HIGH COMISSIONER
2014

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These eight training modules are meant to “inform and empower those who are involved in ratifying, implementing and monitoring the two instruments. While the Training Guide is mainly targeted at facilitators of training courses on the Convention and its Optional Protocol, it acknowledges that each and every one of us has a role to play. I recommend wide dissemination of the training package, and its use by all those who want to embark upon the essential journey towards greater awareness and effective implementation of the rights of persons with disabilities and, ultimately, the building of an inclusive society for all.”

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