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MAANASI - A sustained, innovative, integrated mental healthcare model in South India

JAYARAM, Geetha
GOUD, Ramakrishna
CHANDRAN, Souhas
PRADEEP, Johnson
2019

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Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.

A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term.   Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. 

As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930.  Empowerment of treated clients is the final outcome, assisting them in self-employment. 

Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

 

Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 104-113, Oct. 2019

 

 

Learning from experience: Guidelines for locally sourced and cost-effective strategies to modify existing household toilets and water access

WORLD VISION
CBM Australia
2018

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This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.

To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.

HOME MODIFICATIONS FOR WASH ACCESS
This document is one of two developed in the Jaffna District and describes the strategies which were used to assist people with disabilities to access toilet and water facilities at their own home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka. Houses and toilet structures in the region were made of brick and concrete. No new toilets were built and modifications involved only minor work to existing household structures, water points and toilets.

NOTE:
The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.

Capturing the difference we make : community-based rehabilitation indicators manual

WORLD HEALTH ORGANIZATION (WHO)
2015

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This manual presents indicators that "capture the difference (Community-Based Rehabilitation) CBR makes in the lives of people with disabilities in the communities where it is implemented. This manual presents these (base and supplementary) indicators and provides simple guidance on collecting the data needed to inform them. The indicators have been developed to show the difference between people living with a disability and their families and those without disabilities in relation to the information reported in the indicators. This comparability provides valuable information to CBR managers, donors and government agencies alike, which can be used to guide decision-making, support advocacy and improve accountability. Further, the ability of the indicators to provide a comparison of the populations of persons with disability to persons without disability aligns with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which states that persons with disability have equal rights to those without disabilities...this manual serves to standardize the monitoring of differences made by in the lives of people with disabilities and their families, making it possible to compare the difference CBR makes across areas and countries. This manual aligns with the WHO Global Disability Action Plan 2014–2021, and may also be used to monitor other development plans in an easy and efficient way”

Shifting the paradigm in social service provision : making quality services accessible for people with disabilities in south east Europe

CHIRIACESCU, Diana
December 2008

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This report examines the ways in which policies and practices evolve in the social services sector in South East Europe, as well as the impact of this change process on the lives of people with disabilities. It aims to identify the main stakes, priorities and steps forward that should be undertaken in order to modernise this sector in an effective and sustainable way

The right to live in the community : making it happen for people with intellectual disabilities in Bosnia and Herzegovina, Montenegro, Serbia and Kosovo

ADAMS, Lisa
2008

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This report concerns the situation of people with intellectual disabilities in Bosnia and Herzegovina, Croatia, Kosovo under UN Security Council Resolution 1244, Montenegro and Serbia. It describes how five organisations working in the region have successfully developed innovative services to support people with intellectual disabilities to live in their communities as equal citizens. The aim of this report is to highlight the importance of developing a range of client-focused, community-based services as alternatives to institutionalisation; demonstrate that such services can successfully be developed in the region; identify barriers to the development of such services; and make recommendations on how to address such barriers

Handbook on paediatric AIDS in Africa

TINDYEBWA, Denis
et al
2004

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This handbook intends to provide users in resource-poor countries with a tool that can be adapted to their needs. It follows the four principles of the United Nations Convention on the Rights of the Child and aims to provide a simple, accessible and practical handbook for health workers involved in preventing infection and caring for children infected and affected by HIV. It includes substantial chapters on caring for HIV-exposed and HIV-infected children, infants and orphans; diagnosis and the clinical stages of HIV infection; clinical conditions associated with HIV (diarrhoea, malnutrition, neurological manifestations, skin manifestations and more); pulmonary conditions; anti-retroviral therapy for children; youth issues, long-term and terminal care planning; psychosocial support. The primary targets are medical students and their lecturers, nurses, clinicians, community health workers and other service providers in resource poor settings where there is a significant HIV and AIDS burden

Community-based social services : practical advice based upon lessons from outside of the World Bank

MCLEOAD, Dinah
December 2003

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The purpose of this paper is to gather information outside of the Bank, in both developed and developing countries, on design and delivery of community based social service initiatives. Recommendations are provided for practical advice on project design and to enhance the sub-project cycle for social service-type projects
Social Protection Discussion Paper Series

South African health review 2001

HEALTH SYSTEMS TRUST (HST)
March 2002

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This is a comprehensive, authoritative and independent review of the South African health system. It is published annually and this year's edition is is made up of 17 chapters grouped into four themes: listening to voices, equity, information for health, accountability and transformation. The review acts as a barometer for assessing the transformation processes and their impact on provision of equitable health care to all in South Africa

Equal opportunities for all : promoting community-based rehabilitation (CBR) among urban poor populations. Initiating and sustaining CBR in urban slums and low-income groups

ASSOCIATION AMICI DI RAOUL FOLLEREAU (AIFO)
October 2001

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Most CBR experience has come from rural areas in developing countries. However, even in large cities specific population groups - such as people living in slums or low-income areas in the urban peripheries - may face difficulties in accessing rehabilitation services. To address this, the World Health Organization set up a number of pilot consultations and projects in seven countries (Indonesia, India, the Philippines, Brazil, Bolivia, Egypt and Kenya) in 1995. This document gives a report of a final meeting of representatives of these pilot projects.

Community-based rehabilitation and the health care referral services : a guide for programme managers

WORLD HEALTH ORGANIZATION (WHO)
1994

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This guide describes community-based rehabilitation (CBR) activities as managed by the health care sector. In countries where another sector has responsibility for CBR, the Ministry of Health manages only the rehabilitation services that are part of the health sector, though it may also participates in inter-sectoral CBR activities. The information in this guide is intended for use by rehabilitation management personnel in both of these situations. It is a must for planners of CBR projects. 'Mid-level rehabilitation workers' and their training are also mentioned

Realife trust

REALIFE

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This website presents information about Realife, an action research development agency. The agency's original purpose was to work alongside up to 10 local families and to develop a range of initiatives based on their needs and preferences. Every project undertaken since then has been a result of requests from local people to set something up that they simply cannot find from their local authority or other voluntary agency. Information is oprovided about the services they offer and related news and resoruces

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