Knowledge of the medical services available at primary, secondary and tertiary levels of the health system is essential for assisting people with disabilities and their families to access medical care and support. 

CBR can:

• identify existing medical services at the local, district and national levels, ensuring that government, private and nongovernmental service providers are identified, including providers of traditional medicine, if appropriate;
• initiate contact with the service providers and gather information regarding the type of medical care provided, accessibility, costs, schedules and referral mechanisms;
• compile a service directory to ensure that all information is accessible for CBR personnel, individuals and communities – ensuring that service directories are available in local languages and accessible formats and made available in places where health care is provided.

CBR programmes can:

• establish a mechanism for the early identification of health conditions and impairments associated with disability in partnership with primary health care personnel;
• identify screening activities aimed at the early identification of common communicable or noncommunicable diseases, such as tuberculosis, leprosy, filariasis, river blindness, diabetes, cancer;    
• provide information for people with disabilities and their families about the timing and location of screening activities and ensure they are able to access these;
• ensure members of families that have a history of genetic or hereditary conditions, such as muscular dystrophy, are referred to appropriate medical facilities for assessment and counselling;
• be aware of secondary conditions, such as pressure sores, associated with particular disabilities, and check for these when working with people with disabilities;
• identify people with impairments in the community who may benefit from surgery.

Learn about an awareness-raising campaign in India that provided information about early signs of leprosy.

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CBR run by two non-governmental organizations in the Mandya District of India collaborate with the national leprosy programme. They are involved in awareness-raising activities that provide information about the early signs and symptoms of leprosy and encourage people with suspected lesions to visit their nearest primary health-care service.

People who are diagnosed with leprosy commence a 6- to 12-month treatment regimen, which is provided free by the primary health-care sbuild-your-action-planice. If people fail to attend treatment, the primary health-care service requests the CBR to follow up with these individuals.

CBR can promote and encourage collaboration between people with disabilities, their families and primary health care workers to increase access to medical care services at all levels. Suggested activities include:

• checking with health workers to make sure people with disabilities who have been included in screening activities are provided with follow-up medical care if required;
• checking with health workers to make sure referrals have been made for people with disabilities who require access to secondary and tertiary levels of health care;    
• advocacy, e.g. CBR personnel who know sign language may accompany deaf persons to health facilities to ensure that they are able to communicate their needs and understand the information being provided and support them to access appropriate treatment;
• raising awareness about the barriers that prevent access to medical care and working with others to reduce or eliminate these barriers – innovative mechanisms may be required to address some barriers, such as the costs associated with medical care;
• identifying gaps in service provision for people with disabilities and exploring ways in which these gaps can be reduced or eliminated.

Some people with disabilities may require surgical care. When combined with follow-up care and rehabilitation, surgery can:

• prevent conditions from becoming worse
• contribute to improved functioning.

CBR  can do a number of things to support positive surgical outcomes, including the following.

• Explore which surgical options are available for people with disabilities (and particularly whether funding options are available).
• Before surgery takes place, check to ensure that people with disabilities and their family members have been well informed of the possible risks and benefits of surgery, and are aware of the costs and duration of the entire surgical and treatment plan.
• Following surgery, check to ensure that people are receiving appropriate follow-up from surgical and nursing teams and rehabilitation professionals, such as physiotherapists, occupational therapists, prosthetists and orthotists, to maximize the benefits of surgery, and ensure a smooth transition from medical care to rehabilitation.

CBR can assist people with disabilities and their families to become aware of their right to medical care and to learn skills that enable them to manage their chronic health conditions. It is suggested that CBR:

• works directly with people with disabilities to encourage them to take responsibility for their own health, by seeking appropriate medical care and making healthy lifestyle choices, and ensures that they are able to understand and follow medical advice;
• develops or adapts existing materials and publications that provide medical information about health conditions into formats that are appropriate for people with disabilities and their family members, e.g. by using simple language, simple sketches or pictures and material translated into local languages;
• links people with disabilities with self-help groups to enable them to learn about self-management by sharing knowledge and skills with others, including the resources available for medical care, how to effectively negotiate the health-care system, and how to manage existing health conditions.

Learn how support groups were formed to help people in Nicaragua take responsibility for the management of their own health.

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In Nicaragua, there are “clubs” for people with chronic conditions such as high blood pressure or diabetes. These clubs, or support groups, add to the efforts of the health care system by ensuring that people are able to take responsibility for the management of their own health and prevent the development of further conditions and impairments. 

In club meetings, people talk about their problems, learn how to self-monitor their health conditions and explore solutions such as developing healthy lifestyles. 

Club management committees carry out fundraising activities to help cover the costs of medicines and laboratory tests, which are not usually provided by the health system. The CBR programme collaborates with these support groups to ensure that people with disabilities are included. 

Medical personnel often have limited knowledge about disability and how best to enable access for people with disabilities to medical care services. By making contact with medical services and building relationships with staff, CBR programmes can develop a network that can be used to facilitate referrals and comprehensive medical care for people with disabilities.

CBR can:

• promote awareness among medical personnel about the health needs of people with disabilities and their families;
• organize interactive sessions between individuals and groups of people with disabilities, family members (where relevant) and medical personnel to enable discussion of key issues related to disability, such as access issues, and share experiences;
• encourage medical personnel to involve people with disabilities and their family members in the development of medical treatment and care plans;
• work jointly with community health programmes to ensure that people with disabilities can access the benefits of these programmes;
• request that medical services provide education and training for CBR personnel so they are able to assist with early detection, provide referrals to appropriate services and provide follow-up in the community.

Learn how a multi-sectoral team came together in Indonesia to raise awareness about disability issues.

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CBR in South Sulawesi, Indonesia, has a multi-sectoral team including village health workers, primary-school teachers and community volunteers, many of whom have disabilities or are family members of a person with a disability. 

The CBR team has regular training sessions with personnel from all levels of the health system. These sessions provide great opportunities for networking, promotion of the medical care needs of people with disabilities and promotion of the role of CBR and medical care services.

CBR also organises referral visits for individuals who need surgery and coordinates with district authorities to provide transport to the regional capital for specialized services