SITUATION ANALYSIS OF CHILDREN WITH DISABILITY IN RURAL AREA (MAHARASHTRA) - COMMUNITY BASED DISABILITY PREVENTION AND REHABILITATION INTERVENTION
DR.B.D. ATHANI*
DIRECTOR, AIIPMR, MUMBAI.*
Abstract
BACKGROUND:
58th Round of NSSO 2001 reports the prevalence of locomotor disability in children below 14 years of age as 10.76% Urban and 12.2% Rural of the persons with locomotor disability. Disability in children, especially in rural areas is compounded with multiple disabling factors, viz. poverty, illiteracy, malnutrition, etc. Prevention of disability is accorded highest priority by UNICEF. Besides, UNICEF has advocated Community Based prevention, early detection of impairment and timely intervention to prevent progression to disability.

Rural Disability detection and service camps conducted by the Institute have revealed almost 30% persons attending camps are children. Common causes of disability being Cerebral Palsy, congenital anomalies, muscular dystrophy, MMC, polio, etc.

It is observed that majority of the children and adult population with disability have no access to standard line of treatment or medical interventions as such services are not available in their vicinity as well as unaffordable. Besides medical intervention involves a long drawn out process and not a one time intervention.

Chapter IV of PWD Act 1995 also enunciates the points (c) screen all the children at least once in a year for the purpose of identifying "at risk" cases and (f) take measures for pre-natal, peri-natal and post-natal case of mother and child amongst the other clauses of the chapter to prevent the occurrence of disabilities.

The All India Institute of Physical Medicine and Rehabilitation is a pioneer Institute in the field of Physical Medicine and Rehabilitation for the last 50 years providing services, imparting training and conducting research for the past 50 years. Along with institutional based services, outreach programmes in the rural areas with in the country are conducted on a regular basis.

Institute has been formulating and testing various models of Rehabilitation within the health sector and providing technical assistance and capacity building for referral services in Civil Hospital at District levels in some states of the country for meeting the Medical rehabilitation needs of the rural disabled. Besides the institute had taken up I.E.C. activities on Disability, Prevention and Rehabilitation.
PHC Based Project for Disability Prevention and Rehabilitation
A project "Optimal Enablement of the Persons with Disability by Access to Medical Rehabilitation Services" supported by W.H.O., Geneva, is under implementation by All India Institute of Physical Medicine and Rehabilitation. This project is aimed at developing a PHC based model for integrating Medical Rehabilitation Services for the rural Persons with Disability at grass root level along with the existing promotive, preventive and curative services existent in the PHC.

Primary Health Centre, Poynad in Raigad district of Maharashtra, situated about 100 km from Mumbai catering to a population of 45,000 of 32 villages and having 5 sub-centres in its coverage was selected for implementation of the project.

Objectives outlined include (1) assessing the disability profile by conduct of a door to door survey (2) delivery of services, viz. therapeutic, surgical, fitment of aids and appliances, mobility aids, training in use of them, etc. (3) referral to the Civil Hospital/AIPMR for tertiary care services (4) community awareness (5) follow-up of functional upgradation with intervention.

In this paper aspects related to children with Disability will be dealt with reference to:
  1. The proportion of disability of children with disability referred to PHC and their situation analysis in terms of functional status will be analysed.
  2. Based on the above the intervention strategies plan with parents and community leaders.
  3. Strengthening of Civil Hospital for providing fitment of Aids and Appliances have been planned.
  4. Door to door survey of the entire PHC population has been carried out and the statistics about prevailing disability amongst the children in the entire PHC coverage area will be highlighted and compared with similar studies of paediatric journals in India.

In short, PHC based medical intervention model to benefit unserviced/unreached children with disability as per the needs will be discussed.
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