DECENTRALIZATION

OF REHABILITATION SERVICES

TO PERSONS WITH DISABILITIES IN INDIA

Dr. Dharmendra Kumar

Director

PDU Institute For The Physically Handicapped

4 – Vishnu Digamber Marg, New Delhi

Department of Disability Affairs

Ministry of Social Justice & Empowerment

Government of India

Decentralization of Rehabilitation Services to

persons with disabilities in India

The word Decentralization means redistribution or

dispersal away from a central location or authority.

It refers to the process of distribution of administrative

functions or powers authority and responsibility of a Central

authority among several local authorities.

The meaning of decentralization may vary because of the

different ways it is applied.

It brings the role of civil society and nongovernmental

organisations as partners to the governmental efforts in providing

services to the areas which remain uncovered in a centralized

system of service delivery.

CENTRALIZATION AND DECENTRALIZATION

It is considered as a complex multifaceted concept

which envisages transfer of authority and responsibility for

public functions from central government to subordinate or

quasi-independent government organisations and / or

nongovernmental / private organisations.

Decentralization in any area is a response to the

problems of centralized system. Decentralization in government

has mostly been seen as a solution to problems like economic

decline, government’s inadequacy to fund services, inability to

reach the unreached, general decline in performance of

overloaded services, demands of underprivileged for a greater

say in local governance etc.

DEFINITION OF DECENTRALIZATION

OBJECTIVES OF DECENTRALIZATION

A. Participation:

One of the definition of decentralization refers to the re-

structuring or re-organisation of authority so that there is a system of

co-responsibility between Institution of governance at the control,

regional and local levels according to the principle of subsidiary, thus

increasing the overall quality and effectiveness of system of governance,

while increasing the authority and capacities at sub national levels.

Decentralization entails participation in decision making,

equality and liberty from higher authority.

A counterpoint to globalization” which removes decisions

making from the local & national stage to global sphere of multinational

or non-national interests. Decentralization brings decision making back

to sub national level.

Diversity:

Efficiency:

Diversity is defined as

properties of entities agents or

individuals that are not shared

by the larger group of

population structure.

Decentralization is defined as a

property of a system where the

agents or individual groups have

some ability to operate locally.

Decentralization is said to

increase efficiency and

effectiveness of programme due

to reduction in congestion in

communication, quicker reaction

to unanticipated problems,

improved ability to delivers

services, better information

about local conditions and more

support from beneficiaries.

Conflict Resolution:

It prevents or reduces conflict

because decentralization caters to

regional or local demands.

OBJECTIVES OF DECENTRALIZATION (contd.)

TYPES OF DECENTRALIZATIONS

Based on the aspects it is being applied to it could be:

Political : To give citizen or their elected representatives more power

Administrative: To shift power, authority and responsibility to sub national

level.

Fiscal: Decentralization of revenue raising and/or expenditure to a

lower level while maintaining financial responsibility.

Economic: Privatisation or deregulation which means shifting the

responsibility of providing services from Public Sector to

Private Sector.

Environmental: Leasing of central government owned lands either to private

business man or devolution of control of land use to regional

or local governments.

Technological: Often best decentralised by divestment through privatisation

and free market.

Information Internet is probably the best example of decentralisation where

Technology etc: no one seems to be the in charge and everyone can access it.

FORMS OF DECENTRALIZATION:

There are four major forms of

decentralizations:

a) Deconcentration: Shifts responsibility of decision making, finance and implementation of certain services programmes from central governments officials to district level officials.

b) Delegation: Passes down responsibility of decision making, finances and implementation of certain public functions to semi-autonomous organisations not wholly controlled by the central government, but ultimately accountable to it

c) Devolution: Transfer of all responsibilities of decisions making, finances and implementation of certain public functions to sub national, regional or state government.

d) Divestment: means contracting out services to private organisations by relinquishing all responsibilities of decisions making, finance and implementations of functions.

DECENTRALIZATION OF REHABILITATION SERVICES IN INDIA

A huge multicultural, multi-ethnic and multi-environmental

society

Total population : more than 1210 millions

28 States and 7 Union Territories

672 districts spread all over the country.

The terrains vary from steep hills and mountains to sub

coastal and island areas

The total number of people with disabilities as per census

2001 and NSSO 2002 : 21.9 million & 18.5 million

TYPE OF

DISABILITY

CENSUS, 2001 NSSO*, 2002

Population (in

Million)

% Population (in

Million)

%

L o c o m o t o r

06.1 28 09.7 52

V i s u a l 10.6 49 02.5 14

H e a r i n g 01.3 6 01.8 10

S p e e c h 01.6 7 00.9 5

M e n t a l 02.2 10 01.6 9

M u l t i p l e - - 01.9 10

To t a l 21.9 100 18.5 100

NUMBER OF PEOPLE WITH DISABILITIES IN INDIA

The needs of the people vary according to their habitat and socio-cultural factors

A model of services developed for one region or one place can not be universalized and may not be effectives at all places

The decentralization of services to persons with disabilities as a concept is slowly but steadily being adopted in India

Extending benefits of government programmes is a huge task and require large infrastructure.

WHY DECENTRALIZATION

Main Infrastructure involved in providing Rehabilitation services

to persons with disabilities in India

Government of India Ministry of Finance

Planning Commission

Of India Ministry of Social Justice and Empowerment

Ministry of Woman & Child Ministry of Labour and Employment

Development Department of Disability Affairs

Ministry of Health & FW Ministry of Human R&D _____________________________________________________________________________________________________________________________________________

Schemes and

programmes for persons with disabilities

Institutional Infrastructure

National/ Apex Level Institutes

Statutory Bodies Public Sector Undertaking

DDRS

ADIP

SIPDA

AIIPMR, Mumbai

AIISH, Mysore

NIMHANS, Bangalore

NIRTAR, Cuttack

NIOH, Kolkata

PDUIPH, New Delhi

NIMH, Secunderabad

NIHH, Mumbai

NIVH, Dehradun

NIEPMD, Chennai

COMPOSITE REGIONAL CENRES

Rehabilitation Council of

India

National Trust

Chief Commission for

person with disabilities

Artificial Limb

Manufacturing

Corporation, Kanpur

Auxiliary Production

Centres

Regional Marketing

Centres

National Handicapped

Finance Development

Corporation

COMPOSITE REGIONAL CENTRES

Bhopal, Madhya Pradesh

Lucknow, Uttar

Pradesh

Guwahati, Assam

Srinagar, Jammu & Kashmir

Sunder Nagar,

Himachal Pradesh

Patna, Bihar

Ahmadabad, Gujarat

Kozhikode, Kerala

AIIPMR, Mumbai

NIMHANS, Bangalore

AIISH, Mysore

NATIONAL

INSTITUTES

NIRTAR, Cuttack

PDUIPH, New Delhi

NIEPMD, Chennai

NIVH, Dehradun

NIHH, Mumbai

NIMH, Secunderabad

NIOH, Kolkata

INSTITUTIONAL INFRASTRUCTURE

NATIONAL/ APEX LEVEL INSTITUTES

MINISTRY OF H & FW

MINISTRY OF S J & E

182 District Disability Rehabilitations Centres

Department of Physical Medicine and Rehabilitation in Medical Colleges and Apex level Medical Institutions in India.

Non Governmental Organisations

ADIP - 62

DDRS - 525 821

NT - 234

National Level

Regional

State Level

District Level

INFRASTRUCTURE Contd.

CIVIL SOCIETY/ ACTIVISTS

GROUPS

RIGHTS / ADVOCACY

GROUPS

SELF HELP GROUPS

ICDS WORKERS ANGANWARI

WORKERS FIELD HEALTH

WORKERS

REGIONAL CENTRES OF

NATIONAL INSTITUTES CBR PROJECTS

PRIVATE HOSPITALS AND REHABILITATION CLINICS.

INFRASTRUCTURE Contd.

PROCESS OF DECENTRALIZATION

Infrastructure involved in providing services to person with disabilities

in India spread all over the Nation

A well controlled and balanced system.

It is partly centralised and partly decentralised.

India is probably largest democratic nation

Constitution has ensured equal rights to all its citizens irrespective of

their caste, religion and race including persons with disabilities.

The citizens can participate and are involved in the process of;

planning,

formulation of policy and programmes,

preparation of schemes,

drafting of bills to legally empower the underprivileged sections

who socially and or economically are at a disadvantage and

implementation of provisions of benefits made by the Central

government.

PROCESS OF DECENTRALIZATION

Department of Disability Affairs in Ministry of Social justice

and Empowerment being the nodal Ministry in the Central Government of India for the empowerment of persons with disabilities can be said to be at the apex of centralised system in delivery of services.

This department of Ministry is supported by statutory bodies like;

Rehabilitation Council of India,

Chief Commissioner for persons with disabilities and

National Trust which have been established through the acts of Parliament.

The process of decentralisation has been made effective in a stepwise manner so as to extend quality services to the people living in remote districts and at the same time keep getting essential feedback for improvement and ensure participation in providing services, according to their needs

CONSULTATIVE ROLE OF STAKE HOLDERS IN PLANNING:

The Government of India plans for every five years.

Each department/Ministry has to prepare its programmes, schemes,

projects in advance and propose for the budgetary allocation

Planning, policy making or decision making rests with the Government

Process by which the proposals are made involves a lot of consultation

with the stake holders

Working groups are constituted to make their proposals on different

aspects of empowerment of persons with disabilities

CONSULTATIVE ROLE OF STAKE HOLDERS IN PLANNING:

These working groups consist of members from different walks of life

including social workers, advocacy or rights groups, persons with

disabilities, experts in the field, non governmental organisation beside

government representatives

The working groups after consultation with stakeholders prepare their

reports along with financial implication and submit it the nodal Ministry.

After compilation, these proposal are considered in the Ministry and are

sent to the Planning Commission of India for allocation of budget for

coming 5 hears.

The process of decentralisation begins in real sense at the level of

implementation of programmes

DECONCENTRATION:

Three major schemes of Department of Disability

Affairs which are meant to provide Rehabilitation

services

Assistance to disabled persons (ADIP) scheme to procure

aids and appliances,

Deendayal Rehabilitation Scheme also called as umbrella

Scheme as it covers all aspects of life of the persons with

disabilities including early identification and intervention,

special education, vocational training, leisure and recreation

etc.

Scheme for implementation of Persons with Disability Act

DECONCENTRATION:

ADIP and DDRS Schemes are largely implemented through

National Institutes and non governmental organisations.

Under ADIP scheme the services are extended through camp

approach also.

Choosing the site of camp in a district and areas to be covered

are decided by the District Administration.

Recommendations of the name of locally active

nongovernmental organisation to the Central government for

financial assistance to implement DDRS Scheme also rests with

the District administration and State government officers.

The major decentralisation in the form of deconcentration happens within

Central government itself as different Ministries share different responsibilities

on one or the other aspects of empowerment. e.g.

Early identification and

Intervention

* Ministry of Social Justice

& Empowermen

t

* Women & Child Development

* Ministry of Health & Family Welfare

Education Ministry of Human Resource Development.

Prevention and Medical Intervention

Ministry of Health & Family Welfare

Vocational Training Ministry of Labour &

Employment

Beside these other Ministries also make provisions of services for persons with disabilities in proportionate manner.

DECONCENTRATION:

DELEGATION

To provide quality rehabilitation services the Government of India has established

more than ten National or apex level Institutes and one Public sector Undertaking

These Institutes are autonomous organisations but are fully financed by the

Government

The management of rehabilitation services and decision making authority are

delegated to these Institutes through their Executive Councils.

These National Institutes;

develop manpower,

develop model services,

do research and development,

provide rehabilitation services in specific field, disseminate information and create awareness.

DELEGATION

Though financial and administrative control partly remain with the

government, the responsibility of providing services entirely lies with

Institutes.

There are eight Composite Regional Centres also located in different

States.

They are though considered to be extended arms of the National

Institutes

But they have the responsibility of extending institutional rehabilitation

services and taking appropriate decision as per needs of the people in the

region of their location.

DEVOLUTION:

A very good example of decentralisation of services could be District

Disability Rehabilitation Centres (DDRCs) in India.

The Government has established 182 DDRCs in different States all over

India

There are proposals to establish 100 more DDRCs in near future.

For initial three years these Centres are operationalised by National

Institutes and financed by the Ministry of Social Justice & Empowerment.

Once the Centre starts working in full fledged manner it is handed over

to a local Non governmental organisation.

The entire responsibility of administration, management and providing

services are shifted to a District Management Team(DMT).

The financial support can be obtained from the government

The NGO/DMT can raise the money through their own resources also.

DEVOLUTION

Deendayal Rehabilitation Scheme is mainly implemented

mainly through voluntary / non profit organisations who are

working in the field.

They are directly in touch with beneficiaries and know the

requirement of people living in their region.

90% of financial support is provided to them under the

scheme by Central Government whereas remaining finances

are arranged by them.

The ADIP scheme also is partly implemented through Non

Governmental Organisations

These Organisations are not wholly dependent on

Government for funds.

They are though registered with the Government but enjoy

full financial, administrative and functional autonomy

DIVESTMENT:

In India rehabilitation services to persons with disabilities are not

provided through government resources alone.

Those who can afford are seeking services from private service

providers at a cost.

There are Indian as well as multinational companies who have their

outlets in different cities of India.

The private facilities are not limited to sale of aids and appliances

but also in the field of education, training and medical rehabilitation.

CONCLUSION:

The decentralisation has definitely increased the accessibility

of rehabilitation services to persons with disabilities in India.

It has brought the service providers and beneficiaries closer to

each other where demand articulation has started coming

from periphery.

The process has enhanced the participation of persons with

disabilities in planning, implementation and decision making

Regional diversity of requirement in being dealt more

efficaciously

CONCLUSION:

The services to people with disabilities, being an empowerment measure

to a socially and economically disadvantaged group, will have to be largely

dependant on the central Government for financial assistance.

The services have at one hand have to be provided at subsidised rate to

relatively poor people living in remote areas according to their needs

whereas those who can afford it they can avail it at their choice according

to their needs.

Completely Centralised or Completely Decentralised system may not be

practically implementable in isolation

Both the systems have to co exist and make a balance to sustain services,

enhance coverage and continue empowerment in any developing Nation.

FOR LISTENING WITH PATIENCE