Accomplished development professional having a total of over 10 years experience in management of Non-profits/NGOs/CSR, strategy development, Project writing, Budgeting, Implementation of programs, Participatory rural appraisal, Organizational management, Social marketing, Process documentation and disability & development consulting. Sound academic background of Master in Business Administration & Master in Disability Rehabilitation Administration. Adept in latest technologies & trends, fostering a cohesive work environment for achievement of organizational objectives with holistic team engagement. Currently engaged as Rehab Consultant and Jr. Manager and heading and institute for the rehabilitation & empowerment of persons with disabilities under CSR, JSPL

1. SOCIO ECONOMIC REHABILITATION
IN LEPROSY
Dr. Debadutta Mishra
Rehabilion Consultant
CSR, JSPL, Raigarh.

2. Understanding the problem
• Leprosy rehab still a Medical Model
• Ignored Social and economic implications
• The vicious cycle of Disability and Poverty
• Associated Stigma and Fear
• Segregation & Non-inclusion ‘asylum/Colony’
• Size of the problem of leprosy related disabilities and
the resultant displacements are not known precisely.

3. Contd…..
• Leprosy cured persons are not aware of several
rehabilitation schemes and centers for deformity
care.
• Staff of employment exchanges may not be fully
aware of the need/provisions to register leprosy
cured persons in the disability category.
• Criteria of 40% or above disability (permanent/
partial disability of both upper and lower limbs)
which orthopaedically handicapped persons followed
may not suit the leprosy disabled persons.
• Inadequate awareness of leprosy staff and general
health care staff about location of centers for
registration for employment of PAL.

4. Leprosy & Disability
Disabilities
such as loss of sensation and deformities of
hands/feet/eyes occur because:
Late diagnosis and late treatment with MDT
Advanced disease (MB leprosy)
Leprosy reactions which involve nerves
Lack of information on how to protect insensitive
parts

5. Prevention of Disabilities
The best way to prevent disabilities is:
 Early diagnosis and prompt treatment with MDT
 Inform patients (specially MB) about common
signs/symptoms of reactions
 Ask them to come to the centre
 Start treatment for reaction
 Inform them how to protect insensitive hands/ feet
/eyes
 Involve family members in helping patients

6. Concepts and prospects
• The basic concepts behind rehabilitation are that the
persons affected with leprosy should be restored
back to normal social life or as near as possible.
• Rehabilitation means restoration of economic
productivity leading to economic independence.
• Rehabilitation in the field of leprosy requires greater
efforts than the rehabilitation in other types of
disabled persons because of the question of social
acceptance.

7. Contd…
• The task of removing public fear and at the same
time maintaining public concern and interest may
be difficult but not impossible.
• Efforts to create a broad interest in the social
problems of leprosy afflicted are beginning to yield
good results.
• Patients who are successfully rehabilitated and are
leading normal family life should be taken as role
models and this will give authenticity to the
rehabilitation program and will have the right effect
too.

8. Community Based Rehabilitation
Inclusion
Self-sufficiency
Participation
Social justice
Self-advocacy
Empowerment
Equity

9. Backbone Principles of CBR
50%
75%
90%

10. Challenges to Rehabilitation
• Mind set of service delivery mode
• Difficulty in shifting from institution based mind set to
community work
• Resistance to role change towards facilitator
• Rigidity of hierarchy and bureaucracy that is not
conducive to a ‘bottom-up’, participatory culture
• Lack of skills and knowledge in community work

11. Contd…
• Mind set of ‘beneficiaries’
• Lack of support from policy makers, donors
• Interdepartmental Coordination
• Resource implications for expanded community
based activities
• Capacity building of field workers and managers for
CBR

12. Rehabilitation need to be comprehensive

13. Priority areas for action - 1
• Inventory of existing services
– Use what already exists in the community!
• Focus on disability and related needs
• Integration of PLD in general (rehabilitation)
services
– Disability surgery
– Physiotherapy and occupational therapy
– Socio-economic development programmes (e.g. micro-
credit)
– Education (including vocational and non-formal)
– Disabled Peoples’ Organisations.

14. Priority areas for action – 2
• Promote reverse integration
– Self-care and self-help groups
– POD services
– Rehabilitation services (esp. SER)
– Disintegrating Leprosy villages / colonies
• Implement human rights perspective
– Self-organisation
– Empowerment, capacity building
– Attention for structural discrimination and
dis-empowerment, also in own organisation.

15. Priority areas for action – 3
• Increased attention for environmental and personal
factors
– Empowerment (literacy, self-esteem)
– Poverty reduction (skills for income generation)
– Stigma and discrimination
• Discriminatory legislation
• Stigma among (health) service providers
• Self-stigma
• Research
– Baseline data
– Disability and poverty (and other determinants)
– Effectiveness of interventions (e.g. CBR, stigma, rights-
based interventions)
– Indicators for monitoring and evaluation.

16. Social integrated approach
• Expanding social welfare for PAL into general
communities
• Promoting community participation in CBR
• Empowering PAL, families and communities
• Focus on human rights and equal access

17. Social welfare and services
• Land and house
• Social security allowance
• Education
• Occupational promotion
• Rehabilitation services

18. CBR: A Convergent Approach
Village/Community
leaders, teachers, health
and community workers, Neighbours,
potential employers, etc extended family,
and friends living
close to the person
Persons with a disability
with leprosy
The person with
Local government disability and
units, NGOs, immediate family
disability groups,
specialists, schools,
hospitals, livelihood Provincial and national
opportunities government agencies,
political leaders, media

19. THAN
K
YOU..