National programme on orientation of medical officers working in primary health centres to Disability Management :

Why the National Programme?

The Persons With Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, passed by the Indian Parliament seeks, inter alia, to create a conducive environment in the country to facilitate equal participation of and giving an opportunity to the disabled to join the mainstream and contribute increasingly in the process of nation building. The act also prescribesin Chapter IV (d) to provide training to the staff in the Primary Health Centres (PHCs) to help create better service facilities in thecountry. The Primary Health Centre (PHCs) network in India is largely rural-based and it is the only structure within the health services delivery mechanism, which functions throughout the nook and corner of the country and has got necessary minimum infrastructure to providevarious services for the people living in rural areas. Hence, the Rehabilitation Council of India (RCI) felt that sensitizing the Medical Officers working in the Primary Health Centre on some of the important aspects of disability prevention, early identification, intervention, referral and rehabilitation, valuable services could be rendered to the people of rural areas.

Launching and Implementation of the Programme
The programme was launched throughout the country on 30th July 1999. It s being implemented in two stages. In the first stage, Master Trainers including Medical and Rehabilitation Professionals are trained and in the second, the trained Master Trainers orient the Medical Officers to disability management. The Programme is implemented in various States of the country under the direct supervision of a State Implementation Committee (SICOM) constituted under the Chairmanship of the State Health Secretary or a Designated Officer. The Secretaries/ Representatives of the Departments of Welfare and Education are also included in the Committee to give the programme wider thrust. After the SICOM is formally constituted in a State, the State's Health Department issuesletters to the District Medical Officers/ Civil Surgeons to depute the Medical Officers of the Primary Health Centre to participate in the programme.An Apex Co-ordination Committee is also constituted by the RCI to co-ordinate, monitor and evaluate programme implementation at the country level.

Normally, nine Medical and Rehabilitation Professionals participate in a Master Training batch and 20 Medical Officers participate in a Primary Health Centre Medical Officers' orientation batch. So far, 642 Master Trainers have been trained up to March 04. and 18,519 Primary Health Centre Medical Officers have been trained.

The programme is implemented by selected government and non-government agencies. These agencies have been selected to impart training because of their distinguished experience in delivery of disability/ rehabilitation services and also on the basis of possessing suitableinfrastructure , faculty, laboratory, equipment, etc. The council is in the process of extending the programme to unrepresented states soon.

Strengthening of Institutional Training Capacity by Provision of Training Material
A Manual containing the prescribed curriculum by various experts on disability/ rehabilitation, an Information Booklet incorporating various relevant information like the structure, function, etc. of the RCI, concessions offered to the persons with disabilities by the Central Government, nodal agencies working in the field of disability, special employment exchanges, vocational rehabilitation centres etc., a list of organisations working in various areas of disability in different States/ Union Territories (UTs), a list of concessions offered by the concerned States/ UTs, Video Cassettes on various areas of disability have been provided by the RCI to help the training institutions provide better quality of training.

Expected Benefits of the Programme
The programme is expected to generate the following benefits in the short as well as in the long run.

1. Large scale direct benefit of various services like prevention, early identification, referral, rehabilitation etc. to the rural populace as the Primary Health Centre largely cater to their need;
2. Saving large sums of money in the long run for the National Exchequer as the Primary Health Centre Medical Officers will be able toprevent or identify any disability problem at an early stage, which would otherwise have required huge investments for rehabilitationof persons with disabilities;
3. Increase in the Gross Domestic Product (GDP) as the disability prevalence or impact will be less;
4. Decrease in the severity/ extent of disability in millions of cases;
5. Wide and improved service network for the persons with disabilities even in the remotest corners of the country;
6. Decrease in the magnitude of disabled population;
7. Awareness creation among the health workers through the Primary Health Centre Medical Officers which will percolate to the lowest level as the lower level health workers function within the community;
8. Larger social participation to prevent disability and also creation of a collective responsibility framework in the broad spectrumof the society;
9. Social and economic empowerment of the persons with disabilities;
10. Leadership building in the Primary Health Centre Medical Officers to help create better sensitization in the grassroots level
    which will ultimately ensure better implementation of the Persons With Disabilities Act, 1995;

Uniqueness of the Programme
This programme is first of its kind in the following aspects :

1. First programme on disability aiming to cover all the Primary Health
   Centre of the country;
2. First disability related programme launched and being implemented with the direct involvement of the
   State Health Secretary/Health Department;
3. First disability programme catering exclusively to the needs of the rural population; and
4. First disability programme with a curriculum covering almost all the aspects disability coupled with field experience.