Breaking down Barriers: An inclusion programme in Cambodia

Doctor examing child

Cambodia has one of the highest rates of disability in the world. GIZ is working with the Cambodian government and local NGOs to promote inclusion of persons with disabilities in the health service. That includes a screening and referral system for rural children at risk of long-term impairments.

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Listen to Channtey Heng, Senior Programme Officer, who says people with disabilities are often reluctant to seek medical care because they think people ‚look down‘ on them.

Channtey Heng believes doctors and nurses should learn what it is like trying to get around a hospital with a disability. So the 30-year-old Cambodian, who had polio as a small child and is now experiencing progressive loss of vision, sometimes asks them to try getting into the building in a wheel chair. Or she blindfolds them and suggests they find their offices without being able to see.

Either way, she says, the result of the training is the same. “They tell me, ‘Wow, it’s really difficult,’ and I tell them, ‘Well that’s what a person with a disability feels like all the time.’”

Improving quality and accessibility

After ten years with the Cambodian Disabled People’s Organisation, the young activist is about to start work with the GIZ implemented programme aimed at improving the quality and accessibility of health services for people with disabilities.

Decades of civil war left Cambodia with a legacy of injuries and widespread malnutrition. The health system was wrecked and the country littered with landmines. Today, disease, congenital illnesses and traffic accidents contribute to giving Cambodia one of the highest rates of disability in the world.

This is why Cambodia is one of ten countries where German Development Cooperation has bilateral programmes aimed at strengthening the inclusion of persons with disabilities.

“They think people look down on them”

Like most partner nations, Cambodia has ratified the United Nations Convention on the Rights of Persons with Disabilities.

But according to Channtey Heng, there is much more to be done to inform the population about those rights. And that includes promoting them amongst disabled people themselves.  “A lot of them are poor and lack education. They think people look down on them,” she explains. “They say ‘I’m just a disabled person, I don’t have rights.’ So we let them know that they do.”

Illness and infections can lead to permanent disability

Part of GIZ’s work in Cambodia is promoting the voice of the disabled to overcome stigma and help them get access to health care.

Dr Heike Krumbiegel, until recently GIZ’s Social Health Protection Advisor in Cambodia, cites studies that show persons with disabilities are far less likely than the non-disabled to seek health care when they are ill.  Dr. Krumbiegel says they often do not know where to go for specialized medical and social support services, “and awareness that certain illnesses and infections can lead to permanent disability is generally rather sparse.”

This is why the main focus of the GIZ-supported programme is on preventing disability, through early detection and early intervention. Almost half of all impairments in Cambodia are preventable. These include illnesses in children, such as eye and ear infections which, if left untreated, can cause long-term impairments.

Reaching villagers through “Health Centre Days”

Working with the NGO Handicap International and with two provincial governments, GIZ has set up a screening and referral process.

Staff at health centres in Kampot and Kampong Thom have been specially trained to spot precursors and signs of disability, including learning disabilities for which children can be referred to specialist support services. Elected groups of villagers have also been trained and they encourage parents to take their children to specially designated “Health Centre Days.”

For some, that can mean a five kilometer journey from home. But Samedy Sor, Focal Person for Vulnerable Groups in the Kampot provincial health department, believes it is well worth the trip. “Before, nobody knew about children with disabilities,” he says. But now that health staff have been trained, “they understand the signs and know how to refer the child to the right hospital for help.”

About 10,000 children have already been seen at more than 40 clinics. And Mr Sor hopes even more can be reached. “This project is very important to the children in my province,” he says.

Increasing a child’s chances in life

Child with cleft lip

Vat Varny, born with cleft lip

An example is four-month-old Vat Varny, who was taken to a Health Centre Day by her mother. The baby was born with a cleft lip, which meant she struggled to feed. As a result, she was under weight for her age. Untreated, she would have had difficulty learning to speak. The baby’s mother was given advice on feeding, and agreed to have her referred to a children’s hospital in the city for an operation to correct the cleft lip when she is older.

“Early detection and intervention can increase the child’s independence and ability to access education,” Samedy Sor says. And that means being included in the community and being able to get a job later in life.

Persons with disabilities gain a stronger voice

Bilateral projects such as this are one strand of German Development Cooperation work on inclusion. Making sure the rights of persons with disabilities are given proper consideration in all development work is another. That was boosted by the 2006 UN Convention on the Rights of Persons with Disabilities. As a result, according to Ingar Duering, Head of Project for the Inclusion of Persons with Disabilities at GIZ, “The voice of disabled people as participants and not just as beneficiaries got stronger.”

And she believes it is set to get stronger still with growing debate on how to include persons with disabilities in the post-2015 development agenda.

Seeing ability as well as disability

Cambodian activist Channtey Heng has already started that debate in her own village where few understood the challenges she faced growing up in a poor, single-parent family and where she says, her neighbours looked down on her. Now, she goes back to the village and tells people how she got her university degree and has a good job. “I get them to see my ability as well as my disability,” she says. As a result, she believes her family’s status has improved and people have changed their minds about her. “Sometimes they cry. And they tell me, ‘I need to be like you.’”

Let their voices be heard! 

Heike KuhnA viewpoint by Dr. Heike Kuhn, Head of Unit, BMZ

Question: The 2013 Action Plan aims to enhance the inclusion of persons with disabilities in German development policy. How much of a priority is that for you?

First of all let me assure you that the successful implementation of the Action Plan is strongly supported also by the new BMZ Leadership.

As new head of the ministry's division dealing with poverty reduction, social protection and the inclusion of persons with disabilities it is my professional responsibility to coordinate and promote inclusion. Personally, I  am highly committed to better include persons with disabilities across sectors in development cooperation. Why? It is self-explaining: Nothing about us without us: Persons with disabilities are confronted with so many obstacles already in industrialized countries, so it is of utmost importance to listen to the needs of this vulnerable group in developing countries. I truly believe that inclusion is a vital step towards higher quality of our work: leave no one behind is our attitude, it is a question of respect and values.

Therefore, looking at the Post-2015 processes, it seems obvious that global development based on human rights principles is only possible if the interests and rights of all persons are considered: men and women  with or without disabilities - think about the fact, that this distinction may change from one second to another! Therefore, Germany will actively advocate for the rights of persons with disabilities to be embedded in a future global development framework  - we will not leave anyone behind, respecting and guaranteeing the human rights of all human beings on earth. Due to this, participation and inclusion have been made central pillars of the German position in the Post-2015 discourse.

Question: What is next?

In the near future I personally feel that we will see stronger national and international activities:

National activities: Beyond fostering inclusion of persons with disabilities in bilateral programmes in our partner countries, the Action Plan of my Ministry formulates strategic objectives which concerns the BMZ as an institution and the cooperation with other stakeholders. I personally have a strong interest in supporting the cooperation and dialogue with civil society, in particularly NGOs of persons with disabilities. Our Ministry is currently planning a round table which will focus on the relevance and the different roles of civil society organisations in inclusive development interventions. I look forward to this dialogue - everyone can - and should - bring his or her voice to be heard in this ongoing debate.

International activities: Next week we will gather in New York as the Seventh Conference of States Parties to the Convention on the Rights of Persons with Disabilities (CRPD) is taking place. The implementation of CRPD as well as the great challenge of incorporating the provisions in the post-2015 development agenda will be discussed intensively. With regard to the EU: The incoming Italian Presidency has already submitted a National Action Plan on Inclusion; we have been asked for support as BMZ was first among our European partners with a German national action plan.

In all these fora we will bring our perspective, enabling persons with disabilities to speak out and let their voices be heard - they know best what is needed. Commitment has been there for a long time, but now we need concrete action! That's my point of view!

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