Meeting people in their communities: Access to disability support and healthcare through Community-Based Inclusive Development training in India
By Prof Nathan Grills and Jayme Wearn
For people living with a disability, access to healthcare, support, and community inclusion can have increased challenges. In rural villages in India, where disability can be prevalent, those challenges are exacerbated by a lack of qualified support workers, further compounded by the considerable and sometimes arduous travel required to reach healthcare facilities. Persistent stigma surrounding disability can further marginalize individuals and their families, hindering meaningful participation in community life. This combination of practical and social barriers creates a formidable obstacle to inclusion and quality of life for people living with disabilities in rural India.
Qualified healthcare professionals working in these regions are spread thin, leaving unskilled community members to support people living with disabilities. Grassroots workers and community members, while eager to improve the situation for people with disabilities in their communities, formerly had minimal access to the education, skills and training they needed. Additionally, to engage effectively and legitimately in disability support work, fieldworkers should be certified. Other disability courses required education qualifications that few people living in rural villages and communities had.
In response to these challenges, the Nossal Institute for Global Health and the University of Melbourne in joint collaboration with Department of People with Disability (Ministry of Social Justice And Empowerment) and the Rehabilitation Council of India (RCI) developed the Community Based Inclusive Development (CBID) course. Launched in 2021, the CBID course is a 6-month competency-based course with three key aspects:
- inclusive community development with a focus on how to support people with disabilities to access their rights, entitlements, and available support, and how to mobilise communities to respond to disability.
- primary assessment and intervention for people with disabilities, and
- professional behaviours and reflective practice with a focus on conduct and application of skills in their own communities.
Local fieldworkers, once limited by lack of formal training, are now vital links in the chain of care for people with disabilities. These dedicated individuals do not replace the expertise of physical therapists and other healthcare professionals; instead, they provide primary care, community inclusion support, and complement and extend the reach of the healthcare professional.
The accreditation through the Rehabilitation Council of India (RCI) opens new doors for those who have undertaken the training. Previously undereducated fieldworkers are now able to use this certification to seek the further qualifications and educational progression.
For a fieldworker like Rajveer, the CBID accreditation has provided him the skills and authority to advocate for his community at a government level. He is trusted in his community to support and speak up for both children and adults with disability and mental illness. In his disability learning centre, he works with 22 children with disability from his village and has supported adults with disability to engage in meaningful work and livelihood opportunities.
Rajveer and around 3000 others who have undertaken CBID training are not just providing care in the communities they serve, they’re changing the narrative around disability in rural India, one individual and one community at a time.
The CBID course has just seen its third batch of students complete this impactful training. But these workers, like Rajveer, are often isolated and receive little ongoing support and training. The conversation has recently turned to how to use technology to better support these workers.
This was a key aim of the VirtuCare project and network.
The VirtuCare network includes government, non-government organisations, academic institutions and healthcare providers who focus on improving the level of care to, and inclusion of, people living with disability through education, technology and research. VirtuCare has been able to harness technology to better support CBID trainees. Recently, through a co-design process co-led by Monash University, CBID fieldworkers in Uttarakhand have been part of a pilot project using technological advancements to develop communities of practice. Using Paroli, a telephone-based way of engaging in community discussion developed through Monash University, fieldworkers have been able to engage in peer-to-peer learning so that they can continue their learning once they return to their communities. Additionally, virtual therapy aids and rehabilitation training videos are being developed to be made available to CBID fieldworkers through the ReHap app.
There remains significant potential for the further usage of technology as part of the CBID course and subsequent support for the CBID workers. Technological developments will support authentic, ongoing support for fieldworkers and the ability to continue their training and skill development without the challenges of leaving their communities. This will allow support CBID workers to make tangible improvements in the lives of people with disabilities and in their communities, fostering a more inclusive society for all.
Additional Information
On September 18, a policy and practice forum was held at the University of Melbourne’s newly launched Melbourne Global Centre in Delhi. The forum explored scaling up interconnections to promote the inclusion of people with disabilities in virtual healthcare in India. The event focused on disseminating the VirtuCare project’s findings at a high level and bringing together academic and industry experts to share insights on disability-inclusive virtual healthcare delivery.
This forum hosted by the Australia India Institute and was the second of the University of Melbourne’s Asia and the Pacific Outlook Series.
The VirtuCare Project is supported by the Australian Government through the Australia-India Council of the Department of Foreign Affairs and Trade. It is led by the University of Melbourne and has received in-kind support from partners including Public Health Foundation of India, PRASHO, The George Institute, Monash University, University of Adelaide, The Public Health Foundation, Infosys, the Emmanuel Hospital Association, Mission accessibility, CBM India, St Johns Medical college and eSanjeevani through the Centre for Development of Advanced Computing (Mohali, India).