Journal of Social Development in Africa (1988), 3,1, 39-53 
Approaches to Rehabilitation of 
People with Disabilities: A Review 
HELEN JACKSON + 
ABSTRACT 
Traditional approaches to rehabilitation of disabled people have emphasised 
segregated institutional care, and have largely neglected the need both to 
integrate people with disabilities into their wider community, and for 
community attitudes themselves to be rehabilitated or changed to facilitate this 
integration. This paper reviews institutional and community based strategies 
for rehabilitation, arguing the case for a community orientation but 
recognising some of the difficulties of implementing this effectively in 
developing countries. 
Introduction 
Rehabilitation of people with disabilities may be summarised as meaning to 
integrate or re-integrate physically, sensorially, mentally and/or 
psychologically impaired people into as full and as normal life roles as is 
possible. It implies an understanding of the life role expectations of the 
particular individuals had they been fully able-bodied. Rehabilitation in its 
fullest sense necessitates, on the one hand, maximising the physical and 
mental fitness of individuals and their capacity to work and to enjoy life, 
through interventions ranging from the medical and paramedical to 
counselling and vocational training and job placement; and, on the other 
hand, promoting the accessibility and openness of the physical and social 
environment to people with impairments. Oliver (1983) particularly stresses 
the importance of the latter focus, and discusses the extent to which it has been 
neglected in the historical development of rehabilitation in Britain and 
elsewhere. Yet it is central to the concept of integration, the expressed goal of 
rehabilitation. 
The focus of rehabilitation on the individual rather than on the wider 
community and the physical environment has major implications. It helps to 
+ Lecturer, School of Social Work, P Bag 66022, Kopje, Harare, Zimbabwe
40 Helm Jackson 
keep the problems hidden from the public eye, so that policy makers, 
planners, politicians and others are less likely to take the needs of people with 
disabilities into account. Because the problem is seen to lie within the 
individual and in her/his limitations, the solution must also logically be sought 
at this level, that is, in individual adjustment, rather than in environmental 
accommodation or modification. We have, in effect the syndrome of blaming 
the victim. 
In many countries it is the victims of war, and of these particularly excombatants, 
who have the highest benefits and best access to rehabilitation; 
ironically, wars can be seen historically to have been one of the more effective 
forces in improving rehabilitation policy and services in many countries, first 
for ex-combatants and war victims, and then for wider sections of the 
population. But cause of disablement, rather than simply severity of 
impairment, remains important with regard to access to benefits and services. 
A further obvious differential is the major factor of economic privilege. The 
rich who can pay or have insurance cover, tend to be well provided for, 
regardless of the cause, nature or severity of impairment, or of sex or societal 
contribution of the person concerned; the poor, while at measurably greater 
risk of disablement in the first place, will tend to be comparatively neglected 
except perhaps in the most highly developed universalistic welfare 
programmes. 
Apart from the risk of highly unequal access to services and benefits, an 
individual focus on rehabilitation also contributes to an emphasis on 
institutional as opposed to community based rehabilitation programmes. This 
emphasis forms the main focus of this paper. 
Traditional institutional rehabilitation 
Institutional services, including medical and vocational rehabilitation centres, 
residential homes, special schools with therapy and nursing care, sheltered 
workshops and day centres, to .name the most salient, have formed the 
backbone of rehabilitation services in developed countries, supported to 
differing degrees by financial and material benefits, counselling and other 
support services in the community. However, for disabled people living at 
home, and for their families and friends living or working with them, access to 
support services may vary enormously. Many people, particularly those 
severely mentally handicapped, remain in long term residential care despite 
mounting evidence of the inadequacies of many such institutions (Thomas 
1982). 
In developing countries, rehabilitation has typically developed under 
colonial regimes to serve primarily the colonial elite, and has consisted mainly 
of modern urban institutions modelled on those of the West. The rest of the 
population has generally had little, if any, access to rehabilitation services of
Approaches to Rthabilitation 41 
any kind, although missionaries and other concerned individuals, such as the 
well known Mr Jairos Jiri in Zimbabwe, have managed to provide some 
services on a piecemeal and often impoverished basis. Rehabilitation services 
developed in this way are often unable to do more than provide a very basic 
care service, with little effective psychological, social, educational or 
vocational rehabilitation, as they lack experienced and skilled personnel, 
facilities, equipment and money to do so, and they can in any case reach only 
a small proportion of the population in need. Governments face the same 
problems of scarce resources, and, although they racially desegregate services 
and provide some economic support to rehabilitation institutions in the 
private sector, they cannot afford to build or finance rehabilitation institutions 
for all the disabled in need of rehabilitation or long term care. 
Economic constraints aside, the very concept of institutions caring solely for 
disabled people contradicts the aim of integration. The very nature of the 
service is one of segregation, and the real work of integration can only 
seriously begin at the point where rehabilitation, in this context, ends. It is not 
the acute medical phase of rehabilitation (which may entail hospitalisation), 
but long term therapy, accommodation, education, vocational training and 
employment that are the most critical for the successful integration of people 
with disabilities. In addition opportunities for social contacts and 
relationships, recreation and self-fulfilment are needed. If we are concerned 
about quality and not merely the quantity of life, then it is here ultimately that 
rehabilitation really succeeds or fails, and it is here that the questions of longterm 
institutional care or a community or home-based rehabilitation strategy 
become crucial. 
In developed countries long term institutional care is now widely seen in a 
very negative light, and families who 'put away' their mentally handicapped 
child, for example, may feel very guilty about doing so. Studies such as that by 
Miller and Gwynne (1974), Shearer (1981), and many others, highlight the 
risks of institutionalisation, including the creation of dependency, boredom 
and under-achievement, low self-esteem, stigmatisation and loneliness. These 
problems may be lessened by a 'humanising' of institutions, making them 
more like a home in terms of scale, routine and regulation, and also by 
increasing their openness to families and the community at large — by making 
them less than 'total institutions' in Goffman's sense (Goffman, 1961). But 
such changes, particularly when they involve a genuine shift of power to 
disabled residents themselves, tend to be resisted by both immediate care staff, 
and the administrative hierarchy, despite the evident success of some such 
developments in both hospitals and long term residential homes for disabled 
people (Thomas, 1982). 
In many developing countries it is commonly believed that institutions can 
provide better services than can home care, because they have specialist staff, 
specialised facilities and equipment, special education or vocational training
42 Helenjackson 
on the premises and so on, facilities that are scarce or non-existent in the rural 
areas, and in most urban areas too. Institutional care may be sought also 
because it removes the burden of responsibility and the stigma of disability 
from the family. Particularly among less educated, poor, rural families, 
disability can be an intolerable economic burden to the family, and the cause 
of severe social and family problems because of the widespread stigma 
attached to disability and suspicion as to its causes (WHO, 1984). For example, 
the birth of a disabled child in Zimbabwe may be interpreted as being due to 
witchcraft, to offending ancestral spirits, for example through adultery by the 
mother, or to some other curse. 
Underlying conditions in developing countries may be seen, ironically, both 
to promote the appeal and to reduce the appropriateness of centralised, urban 
institutional rehabilitation. Most people live in rural areas, and the very lack 
of transport, adequate medical and nursing care, schools, time, skills, money 
and material resources needed for the rehabilitation of the disabled make such 
institutional care seem a valid solution. It resolves all these problems at once, 
at least temporarily. The scarcity of institutions and competition for places in 
the few there are may further enhance their appeal. However, at the other end 
of the 'rehabilitation' process, those discharged from such institutions often 
experience stigmatisation and rejection because of their stay there. One 
example of this in Zimbabwe is the dismissive reference to people who have 
stayed in institutions of the main organisation for mentally handicapped as 
'Sascams', after the organisation's previous name. This name has become 
widely associated with mental handicap, and with uselessness. 
In the long run, centralised institutional care is likely to fail as a 
rehabilitation strategy for independence and integration of the disabled into 
their society precisely because it separates the disabled from the family, 
community and normal home environment. By removing responsibility for 
the disabled person from the family and the community, the development of 
understanding of the disabled person's needs and of her/his capacity to 
contribute to society is inhibited. It does nothing to reduce cultural fears and 
beliefs about disability, nor to create a climate of acceptance for the disabled 
person's return — quite the contrary, the family learns to live without the 
disabled persons, and to take over any roles or tasks they might have 
performed. Removal from the family also reduces the chances of the disabled 
people themselves learning to cope with their normal, usually rural, 
environment, both in a cultural and a practical sense. Activities of daily living 
and those related to productive work are very different in a poor rural setting 
compared with a modern, urban institution. In short, long term institutional 
care is probably the worst possible strategy for promoting integration of the 
disabled into their communities. It is also, of course, prohibitively expensive 
as a rehabilitation strategy aiming to reach all the disabled in a developing 
country. For this reason also it is inappropriate. Existing institutions generally
Approaches to Rehabilitation 43 
suffer from a chronic shortage of funds, skilled personnel and equipment, and 
are likely to have a poor staff-rehabilitee ratio and long waiting lists for 
admission. These problems are exacerbated by the difficulty of discharging 
people when follow up services are poor. The urban siting of most institutions 
also skews resources away from rural areas, thus contributing to their 
comparative underdevelopment. 
Community based rehabilitation 
The alternative strategy for rehabilitation places the primary focus on 
community care or family care, with institutions playing a support role rather 
than being the main rehabilitation resource. Community based rehabilitation 
has been promoted for several years by the WHO, UNICEF, the ILO and other 
international organisations, and it is gaining increasing acceptance by 
governments and NGOs in many developing countries. The WHO (1980) 
suggest that specialist rehabilitation institutions be used for complex medical 
and paramedical services for acute and special needs; for research; training; 
workshops for more complicated aids and appliances; coordination and 
planning; and bases for mobile units such as eye units, amongst other possible 
functions. They should be the last possible stage in a referral chain starting 
with families and village health workers-(or equivalent), and the first stage for 
referral after acute, severe injury. The aim of Rehabilitation Institutions 
should be short term intensive care rather than long term, except in some 
extreme cases, and their specialist services should genuinely be available to 
those most in need of them. 
The WHO concentrates mainly on the medical and paramedical aspects of 
rehabilitation, but a move away from institutional segregation is both possible 
and desirable for education and vocational rehabilitation as well. Disabled 
children can attend normal schools in the community, if they can get access to 
them — this means both transport to reach the school and accessible buildings. 
For those with special learning needs, the sensorially or mentally impaired, 
especially classes may be needed in some subjects, but integration in others 
may be feasible. Teachers in ordinary schools can be given extra training in 
block or day release to cope with the needs of disabled children; specially 
trained teachers can visit normal schools; simple aids can be developed to 
overcome a variety of problems. A problem-solving strategy can be adopted, 
with the central focus of maximising the integration of children with different 
disabilities into as normal an educational environment as possible, and with 
the aim of maximising their abilities and opportunity for normal development. 
Then, as Miles (1985a) describes in Pakistan, a great deal may be achieved for 
these children at far less cost, both economic and psychosocial, than special 
schools would entail. 
This integrated approach may begin at pre-school, as, for example, the
*4 Helen Jackson 
Down's Children's Association of Zimbabwe is currently attempting with 
apparent success. It may also be extended into different forms of vocational 
training and work. All too often sheltered employment for disabled people fails 
to operate as a training ground for open employment, and becomes instead a 
dumping ground for many people with disabilities that need not preclude 
them from productive work. It is not, in fact, their physical impairment that 
forms the crucial barrier to open employment, but the physical and social 
environment — inaccessible transport and buildings; non-adapted tools and a 
lack of appropriate aids and appliances; and employers' prejudices and fears. 
In addition, underlying these immediate difficulties, the disabled person's 
own long term development may well have been unnecessarily stunted with 
respect to general education and acquirement of skills, and to self-confidence 
and social interaction. Self-employment and subsistence activities may 
likewise be problematic for reasons extraneous to the actual impairment itself. 
Integrated education, normal home life, integrated vocational training and 
strictly temporary sheltered employment may do far more to achieve the long 
term economic independence and social integration of disabled people than 
supportive but dependency creating sheltered workshops, which should be 
maintained exclusively for long term occupation for seriously impaired 
individuals, and as a very temporary measure for less seriously impaired 
people for specific purposes — assessment, vocational guidance, and so on. 
Most importantly, vocational training must relate to the individual's needs 
outside the training setting, and to the opportunities that will be available. 
Training for its own sake, divorced from opportunities for practical 
application, serves no valid function. Yet in developing countries such as 
Zimbabwe this typifies much current practice (Dube 1986), leading to 
bottlenecks in sheltered workshops as rehabilitees cannot move on into open 
employment or to adequate subsistence activities. Removing vocational 
rehabilitation from a segregated setting to integrated training centres or to 
training in the community, focusing on the most useful skills for the disabled 
person, would be an extension of a practical problem-solving approach with 
direct, meaningful results for the disabled person. All too often the disabled 
people in a specialised vocational training centre have the choice of a few 
selected trades which they are considered to be capable of learning, and little 
attention is paid to the likelihood of the successful use of that trade later on. 
Placement officers may be employed by the centre, but the primary focus is 
the training programme itself, rather than job placement at the end of it. The 
disabled person is often left, at the end of the programme, to face 
unemployment, sheltered employment, or a tough struggle to survive utilising 
an inappropriate skill. 
Community based rehabilitation can potentially encompass the whole range 
of rehabilitation services with greater success than the expensive, 
segregationist strategy of institutional care. The main advantages of such an
Approaches to Rehabilitation 45 
approach may be summarised as follows: 
— it is much cheaper than institutional care, and therefore has the potential 
to reach all disabled people, not just a select few; 
— it avoids dislocating people from their communities, and the risks of 
institutionalisation, psychological scarring, and the creation of 
dependence; 
— it trains people to cope directly with the environment in which they will 
live, using resources that are largely available locally; 
— it improves detection and referral, greatly reduces problems of transport 
and access, allows easy supervision and follow up, and continued support 
for the whole family; 
— it can ensure that disabled people learn useful skills that are directly 
applicable in their environment, thus promoting their self-sufficiency and 
also their capacity to contribute directly to their own society; 
— it promotes community and rural development by creating jobs: 
rehabilitation workers can be drawn from the local community, many 
simple aids and appliances can be produced locally using local materials 
and skills as far as possible, and disabled people themselves may be 
trained to work for the rehabilitation of others; 
— by keeping disabled people in the community it enhances family and 
community understanding and acceptance of disabled people, and an 
understanding of the causes and treatment of impairments. This will lead 
to better prevention of impairments, earlier detection and treatment of 
potentially disabling conditions, and lessened ostracism and social 
handicapping of impaired individuals; 
— it leaves rehabilitation institutions free to concentate on acute and severe 
disability or special needs requiring highly technical intervention, and on 
research, development, training and other functions that make rational 
use of specialised and scarce resources. 
Thus a well developed community based rehabilitation strategy can be seen 
to have major benefits for people with disabilities, for their families and for the 
community itself. For governments with a commitment to the welfare and 
development of their people this approach provides the possibility of effective 
rehabilitation for all without the crippling expenditure of institutional care. 
Indeed, as reported by Rehabilitation International and a United Nations 
Expert Group (1981), well developed community based rehabilitation, in 
combination with well developed primary health care and disability 
prevention, is far more cost-effective than the alternative of having most 
disabled people not rehabilitated. This is a crucially important consideration 
for hard-pressed governments with many other demands on their budgets. 
Of as great importance, however, is the long term conscientising effect of 
community based rehabilitation strategies. They hold out the possibility of 
challenging at source the widespread belief in the hopelessness of disablement.
46 Helen Jackson 
The immediate family and perhaps neighbours can not only see, but also be 
instrumental in planning and promoting the disabled person's progress and 
development, thus demystifying disablement and also the rehabilitation 
process. If children at school learn to accept the presence of disabled 
counterparts, they will grow up to think of people with disabilities as part of 
mainstream life, rather than pariahs. Teachers, employers and other members 
of the wider community will also gradually learn from example and experience 
that disabled people do not need to be set aside, but can in fact contribute as 
much as anyone else to their communities, given the right support and 
opportunity. Indeed, employers of disabled people tend to report a greater 
work commitment by disabled people than the able-bodied, perhaps partly 
because of their great difficulty in securing employment in the first place 
(Lonsdale, 1984). 
The very experience qf disablement, and of the need to struggle to achieve 
the independence that most others can take for granted, may make a disabled 
person special in a very positive sense. Community based rehabilitation of the 
disabled and their integration into community life will help to alert people in 
general to this, and perhaps even more importantly, to the recognition that 
people with disabilities are normal people with a particular area of need or of 
functional loss. Of course, able-bodied people are also susceptible to illness 
and to temporary or permanent disablement themselves, and if they live to old 
age are highly likely to experience progressive disability. These two groups, 
able-bodied and disabled, actually reflect a continuum rather than discrete 
categories, and a person's position on the continuum is liable to change over 
time, even from one day to the next. When this is recognised in communities, 
real integration becomes much more of a possibility. 
Strategies for Community Based Rehabilitation 
Community Based Rehabilitation itself can take a variety of forms, but with 
the essential common feature that the orientation is towards the disabled 
persons in their community, or directed at the relationship between the two, 
and not at the disabled person in isolation. Work normally takes place in the 
person's home, or in a local setting such as a clinic, school, local meeting place 
or club, or perhaps in a local rehabilitation centre or village, as successfully 
developed in Mexico, the Project Projimo, and now being attempted at 
Bindura in Zimbabwe. The emphasis is on rehabilitating people in the type of 
environment in which they live and with which they have to cope, and to train 
them to do the tasks and daily living activities and work that are useful both to 
the disabled person and to the family •— and ultimately to the community as 
well. In the rehabilitation village in Mexico, as reported by Sanders (1985), 
the mothers or other caretakers stay for a few days, weeks or even months with 
their disabled children, and share the learning experiences with each other.
Approaches to Rehabilitation t7 
Simple aids and appliances and ways to achieve basic goals are developed 
during the stay, and there is continuing support after they return home. 
This type of approach has also been developed extensively and successfuly 
in Peshawar, Pakistan, where home based rehabilitation on the WHO model 
outlined below was considered inappropriate. Miles (1985b) calls this work in 
Peshawar 'community oriented rehabilitation', and advocates the need for 
flexibility of approach, using home rehabilitation, local day rehabilitation 
centres, special and normal schools, local rehabilitation centres with 
residential facilities, and so on, as appropriate. The cornerstone of his 
argument is that community participation is vital at all levels of rehabilitation, 
from the initial planning of the services required to their financing and 
establishment, day to day running, and future functions. In the Peshawar 
schemes rehabilitation was developed 'organically' with concerned people in 
the communities saying what their needs were and how they thought they 
could be met, and then being supported gradually to develop the services they 
requested, with some external funding and expertise, but only to a limited 
extent. Miles reports that much of the momentum for development of services 
came from the community members themselves, once people were given the 
possibility of doing something and they could see the achievements of other 
neighbouring programmes. 
The model of home based care developed by WHO and UNICEF over the last 
few years involves training a family member or neighbour to work in the home 
with the disabled person, using carefully developed training manuals (WHO, 
1980, 1984). There should be regular back up from trained supervisors at 
community worker level, village health workers or community rehabilitation 
workers, and a chain of referral and supervision for complex cases. Red Cross 
is developing this strategy in two rural areas of Zimbabwe, with their own 
modifications. Red Cross volunteers are the basic level motivators and 
trainers, backed by the Red Cross team, and by rehabilitation workers at 
different levels trained and employed by the Government. Zimcare, the 
government sponsored organisation for mentally handicapped people in 
Zimbabwe, also runs a highly successful home-based rehabilitation scheme 
using simplified training manuals developed locally. 
. The WHO approach has been criticised by Miles (1985) for attempting to be 
too universal, for taking a top-town prescriptive approach, and for lacking 
sensitivity and flexibility in local application, amongst other factors. 
Nevertheless, the original manuals have been revised (WHO, 1984), and are 
being further reviewed, and they may be very useful in certain circumstances 
— for particular families, as training manuals for trainers at different levels, 
or to stimulate local or national developments more suited to local 
circumstances. 
In most community based rehabilitation schemes, one essential component 
is referral to more specialised treatment, assessment, training, medical or
48 Htlenjackson 
other intervention, and provision of more complex aids and appliances if 
required, for example hearing aids. Community based rehabilitation schemes 
may be limited in their effectiveness if referral chains break down and people 
needing urgent or intensive treatment are overlooked. They will work most 
effectively where there is well developed primary health care, and a good 
general referral system for preventive, curative and rehabilitative treatment. 
Nonetheless, as Werner (1983) emphasises, much can be achieved at 
grassroots level even if specialist services are unavailable or limited. For 
example, children with poor hearing or eyesight can be screened very simply 
using games involving other children, and those affected can be helped at 
school by being placed near the teacher and the blackboard, and by clear 
enunciation, even if hearing aids or glasses are not available. These children 
might otherwise be considered unintelligent or lazy because of their slow 
learning, while it is in fact due to sensory impairment, and they might well 
become psychologically scarred and backward over time. 
Thus an imaginative use of capacities and skills in the community itself can 
achieve results. This is a point strongly emphasised by Werner (1983) — the 
need to value, respect and develop the potential already existing in the 
community, and to mobilise the community for its own development, rather 
than slipping into the common assumption that trained professionals have the 
monopoly of skills, knowledge and insight, and 'know what's best' for the 
people. Miles (1985) exemplifies this understanding and approach very 
convincingly. 
In this context, both the identity of the medium and the form of the message 
itself require imagination. A recent development in some countries has been 
the involvement of children as assessors, monitors and rehabilitators, with 
positive results for common problems such as childhood malnutrition, 
diarrhoea and disablement (Guthrie, 1983; Werner, 1983). Guthrie is 
Director of the Child-to-Child Programme, one of the achievements of the 
1979 International Year of the Child, which is reported to be promoting this 
approach in over sixty countries, and with, on early evaluation, considerable 
success. The Programme took as its starting point the observation that many 
children are looked after primarily by older siblings for much of the time. 
Children also learn easily, are often grouped together, as at school, and may 
be a highly valuable health resource if exposed to relevant concepts of health 
promotion, prevention of disease and disablement, care and rehabilitation. 
The example cited above (Werner, 1983) illustrates one possible use of 
chijdren for simple screening/or sensory impairment. 
Disabled people may also be highly successful as rehabilitation workers, 
precisely because of their personal experience of disablement and its problems. 
In the Projimo village rehabilitation scheme cited earlier (Werner, 1983), 
many of the rehabilitation workers are themselves disabled, having been 
selected not on any remedial basis, but because they were the best applicants 
for the job.
Approaches to Rehabilitation 49 
Women also, through women's clubs and other organisations, may be a 
potent force for health promotion and rehabilitation work, particularly as their 
home-centered roles make them pivotal to the well-being of the whole family. 
Development workers at all levels have traditionally focused far more 
attention on men than on women, but the need for a refocus is begining to be 
more clearly understood. Nevertheless, much more development in this 
direction is needed. 
Apart from the question of who in the community should be the primary 
targets for training as health and rehabilitation educators and trainers, there is 
the question of how messages can most successfully be conveyed. Freire's 
work on conscientisation (Freire, 1972; Hope and Timmel, 1985) focuses on 
the need for active community involvement in the identification of problems, 
and in the learning process, through active questioning and discovery. This 
may include approaches such as drama to illustrate problems and possible 
solutions; story telling; songs; pictures; games and so on — whatever is 
culturally acceptable, enjoyable, interesting and challenging. The vital point 
is that it engages people, and that a dialogue is established in which all can 
contribute their ideas, experience, knowledge and skills, as a means of 
identifying and resolving problems. 
One further aspect of the question of who initiates and promotes activities 
and programmes must also be considered. On one hand, people may relate 
best to a local person whom they respect, trust and can identify with, and who 
knows and identifies clearly with them — someone who is very much part of 
their community. On the other hand, there may be situations in which an 
outside expert can play a useful role in indicating the importance of something 
undervalued by the community. For example, Dr Laing, a community 
physician in Zimbabwe, has spent time personally supervising the building of 
ventilated pit latrines (Sanders, 1983), because, he argues, as a well-known 
doctor with high prestige in the community his presence lends status to the 
task of building such toilets, and will encourage the people to value them 
highly also. 
Some difficulties in developing Community Based Rehabilitation 
Underlying successful community based rehabilitation and primary health 
schemes must be a focus on community development in a much wider context, 
and development of the community by the community, with support but not 
domination from outside. Lip service is widely paid to the need for community 
participation, but the work of such practitioners as Freire, Werner, Miles and 
others, indicates how vital this concept really is. Nevertheless, major barriers 
lie in its way. 
At the most general level, many governments lack a political committment 
to equitable development in the first place, and those adopting ostensibly 
socialist policies can be seen historically to tend often towards centralism,
52 Helm Jackson 
understanding of what is involved, and their control over the rehabilitation 
process. This will make it far more likely that the aid or appliance will be 
regularly and effectively used, and will be likely to build up a greater 
confidence in the family that they can do something directly to help their 
disabled members, or that they can help themselves. This is in itself potentially 
a very liberating and important consideration. 
Conclusion 
It would seem that some form of community based or community orientated 
rehabilitation is the only feasible strategy to attempt to meet both the 
immediate physical needs of disabled people, and the long term goal of 
community conscientisation about health care, prevention of impairments, 
rehabilitation of the disabled and their full acceptance into the community. 
Centralised institutional care fails to educate the community, and imposes 
further psychological stress and isolation on already stressed people, whilst 
rehabilitating them to cope with an environment different from their own. In 
the wider context, community based rehabilitation can be seen as part of the 
general aim of rural development, whereby resources of cash, materials, 
services, jobs, and, crucially, human potential are promoted in the rural 
areas. For people with disabilities it offers the possibility of real integration, 
and not the segregated rehabilitation of the institution. Different countries and 
districts need a strategy appropriate to their particular constraints and 
demands, and one that can be developed with flexibility to meet their 
particular needs in ways that are culturally acceptable and practically and 
economically feasible. 
It is to be hoped that more developing countries will experiment with and 
expand community rehabilitation services, and incorporate this type of 
strategy as the cornerstone of national policies on rehabilitation. The potential 
benefits extend far beyond the immediate needs of disabled people, into the 
enrichment and development of the general community itself, and can be 
identified as incorporating both humanitarian and economic considerations. 
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Journal of Social Development in Africa (1988), 3,1, 55-69 
Social Science in Africa: Problems and 
Prospects 
LEONARD BLOOM + 
ABSTRACT 
The aim of this paper is to examine the delicate relationship of social science in 
Africa to the political, social and administrative context. It is argued, in 
contradition to the defeatist views of, for example, Mehryar (1984), that social 
scientists do both their profession and their societies a disservice if they 
surrender the study of social problems to politicians and administrators. 
Social science and social policy 
Few, if any, African societies have escaped traumatic economic, political, 
social and technological changes since Independence. As a result, values and 
practices, organisations and institutions that once suited a community's 
needs, now collide with innovations, often with unpredictable and socially 
disruptive consequences (Bloom and Amatu, 1983; Uchendu, 1977). These 
interactions may be initiated from within Africa or introduced from outside, 
but, in either case, their consequences, both short-term and long, are hard to 
predict and even more difficult to moderate. 
Social policies are designed in an ideal world to deal with the consequences 
of change. Marshall et al (1978) have analysed the two fundamental questions 
which guide them, and although they wrote about the more industrialised 
urbanised societies, where the social sciences have a longer history of 
cooperation with government, their questions apply equally to Africa. 
(1) What are the concealed and the open theories of social justice that arc used 
by government to justify their policies? (2) What does government know, or 
believe, to be acceptable to the communities or groups that will be affected by 
these policies? 
In Africa, even in formal constitutions there are scanty signs that 
governments recognise the need to articulate either question. On the contrary, 
despite the widely differing social and political systems in Africa, a few 
•Principal Lecturer, Department of Social Sciences, South Bank Polytechnic, London Road, 
London SE1 OAA.