Progress and Challenge of Community-Based Rehabilitation Programs In the Palestinian Territories

Background: Currently, 50.2% of the Palestinian population are children under the age of 18. Since 1990, community based rehabilitation programs have been part of a long-term strategy aimed at strengthening the rehabilitation sector as a whole in order to address the needs of disabled people. Research in the area of disabilities has focused on special education placement of mentally handicapped children (Khamis, 1993a,1997; Fasheh,1986) and efficacy of rehabilitation programs (Khamis,1993b). By contrast, little is known about availability and efficacy or services for developmental conditions such as autism.

Objectives: To survey and systematically evaluate community-based programs for developmental disorders, including autism available to the Palestinian population.

Methods: A systematic review was conducted of published and unpublished analyses by the Palestinian Authority Ministry of Health, various reviews, studies and research on disability and rehabilitation carried out in the area. Moreover, on site visits and interviews were conducted with service providers and major stakeholders, and with beneficiaries.

Results: Very little data is currently available on disability in Palestine. The most comprehensive data is from a 1996 Palestinian Central Bureau of Statistics health survey that found that 1.7% of children aged 0-14 have some form of disability. No data was available specifically on autism. There are also no comprehensive national programs for rehabilitation, but many successful small experiences, such as independent centers operate successfully. There is a clear lack of qualified professionals and paraprofessionals in the field of disability and rehabilitation except for a few specialized professionals in physiotherapy, speech therapy, occupational therapy and special education. There is lack of coordination between the three levels of rehabilitation on the National level. Notably, most Palestinian children with special needs have been cared for at homes rather than in institutional settings.

Conclusions: Community-based programs have a pronounced impact on individuals with disabilities and their families. These programs also have a positive impact on awareness, attitudes and practice towards individual people with disabilities in their local communities. There is a clear need for strengthening capacity of the community based program workers as a step towards the development of a national rehabilitation program. In the long term, we propose adopting a population ‘needs’ based approach for decision-making about resource distribution across different areas and priorities for future service development.