By Sarah Rule

1. HEALTH, REHABILITATION AND THE UNITED NATIONS CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES By Sarah Rule

2. Quiz • A person who is blind has the right to be a witness in a court case Agree Disagree • I would help to promote the inclusion of a child with intellectual disability and severe behavioral problems in the classroom of my own child. Agree Disagree

3. Quiz • I or my wife would have an abortion if I found out that my baby was going to have a disability Agree Disagree • The South African government is required to provide personal assistance to people with disabilities so they can live independently in the community Agree Disagree

4. Quiz • South Africa has ratified the UN Convention on the Rights of Persons with Disabilities Agree Disagree • South Africa has legislation that outlaws discrimination on the basis of disability Agree Disagree

5. What is the Convention on the Rights of Persons with Disabilities? • International Convention • First to codify the rights of people with disabilities • Drawn up by government representatives and representatives of organisations of people with disabilities • 50 articles in the Convention and 18 in the Optional Protocol

7. History of the CRPD • Drafted between 2001 and 2006 • Accepted by the UN General Assembly in December 2006 • Opened for signing and ratification in March 2007 • Came into force internationally in May 2008 • First reports due to the Committee in May 2010 • The UN Special Rapporteur on Disability is South African – Mr Shuaib Chalklen

8. South Africa and the CRPD • Signed the Convention and the Optional Protocol in March 2007 • Ratified the Convention and the Optional Protocol in November 2007 • Progressive realisation of the rights enshrined in the CRPD, however South Africa is legally bound to respect these rights • South Africa has yet to submit its first report to the Committee

9. Structure of the CRPD • Preamble and Articles 1- 4: general introduction, principles and obligations • Articles 5 – 30: substantive rights of individuals with disabilities • Articles 31 – 33: obligations on a national level • Articles 34 – 50: issues related to the Committee, reports and the CRPD • Full text at www.un.org/disabilities/documents/convention/convoptprot-e.pdf

10. Examples of substantive rights • Article 9 – Accessibility • Access on an equal basis to others to the physical environment, transport, information and communication • Article 12 – Equal recognition before the law • Article 17 – Protecting the integrity of the person • Right to respect for a disabled person’s physical and mental integrity on an equal basis to others • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 29 – Participation in political and public life

11. What is disability according to the CRPD? • Disability is an evolving concept and • Disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with other Preamble, Convention on the Rights of Persons with Disabilities

12. Case Study • Teen B is an 18 year old with cerebral palsy who functions intellectually at the level of a pre-school child. • She lives in an institution but visits her family every 2nd weekend and in the school holidays. • She receives services from an NGO. • The mother of Teen B mentioned to the NGO that they were waiting for medical aid approval for an operation to remove Teen B’s breasts. • Teen B had had a hysterectomy at the age of 14.

13. Case Study • The reasons for the breast removal were not completely clear but seemed to be motivated by the parent indicating that Teen B likes taking off her shirt when Teen B’s sister and boyfriend are around. • Neither the NGO nor the institution where Teen B lives had noticed any sexualized behaviour from Teen B. • Teen B’s parents found a plastic surgeon who was willing to remove the teenager’s breasts although there was no malignancy or family history of breast cancer.

14. Reflecting on the case study • What issues of concern do you identify in this case study? • What rights of Teen B may have been violated? • What is the responsibility of the State in this case? • What is the responsibility of the medical profession in this case? • And the NGO? • How could similar situations be avoided?

15. What does the CRPD say about health? • People with disabilities have the right to retain their fertility on an equal basis with others (Article 23) • People with disabilities have the right to decide freely and responsibly on the number and spacing of their children (Article 23) • People with disabilities have the right to the same range, quality & standard of free or affordable health care that is available to others (Article 25)

16. What does the CRPD say about health? • States shall provide health services required specifically because of disabilities, including early identification and intervention and services to minimise and prevent further disabilities (Article 25)

17. What does the CRPD say about health? • Governments must provide these health services as close as possible to people’s own communities, including in rural areas • Health professionals need to provide care of the same quality to people with disabilities as to others, including on the basis of free and informed consent • Governments must prevent discrimination against people with disabilities in health insurance and life insurance • Governments must prevent discriminatory denial of health care or health services or food and fluids on the basis of disability (Article 25)

18. What does the CRPD say about rehabilitation? • Governments must organise, strengthen & extend comprehensive rehabilitation services particularly in the areas of health, education, employment & social services • Rehabilitation should involve multidisciplinary assessment of individual needs & strengths • Governments shall promote the initial and continuing training of professionals and staff working in rehabilitation (Article 26)

19. What does the CRPD say about rehabilitation? Rehabilitation must support inclusion & participation in the community

20. What does the CRPD say about rehabilitation? Rehabilitation should be available to people with disabilities as close as possible to their own communities, including in rural areas

21. What does the CRPD say about rehabilitation? Governments shall promote the availability, knowledge and use of assistive devices

22. Implications for rural health and rehabilitation • The practice of rural health and rehabilitation needs to be in line with the CRPD • The CRPD provides leverage for disability and rehabilitation to be fully included in the re-engineering of PHC • Participation in monitoring and reporting on the provisions of relevant articles of the CRPD • Informing people with disabilities of their rights as a means of empowering them • Possibility to contribute to the development of a new national disability policy

23. Implications for rural health and rehabilitation • The government needs to report on its implementation of the CRPD in 2014, some of the following could be monitored & advocated for or challenged: • Allocation of budget & other resources for implementing provisions of the CRPD • Allocation of resources and support for training appropriate personnel (both initial and continuing training) • Cases where the rights of people with disabilities have been violated

25. THANK YOU!