The following organizations supported and participated in the seminar;

• National Rehabilitation Center for the Disabled, Japan
• WHO Regional Office for Western Pacific
• Prime Minister's Secretariat, Japan
• Ministry of Health and Welfare, Japan

For further information on this declaration can be requested to

4-1 Namiki, Tokorozawa City, Saitama Pref. Japan

ZIP 359-8555

In 1992, 33 countries, attending the forty-eighth session of the Economic and Social Commission for Asia and the Pacific (ESCAP), adopted Resolution 48/3 on the proclamation of an Asian and Pacific Decade of Disabled Persons, 1993-2002. This was an expression of the collective commitment of governments of the Asian and Pacific Region to the full participation and equality of people with disabilities.

On 10-14 November 1997, a seminar to mark the mid-point of the Asian and Pacific Decade of Disabled Persons, 1993-2002, was convened in Tokyo, Japan, by the National Rehabilitation Center for the Disabled of Japan and the WHO Regional Office for the Western Pacific in collaboration with the Prime Minister's Secretariat, other Japanese Government agencies, the Japanese Society for Rehabilitation of Disabled Persons, and other consumer organizations. Before the seminar, a quick assessment of progress made towards achieving the objectives of the Decade was undertaken through questionnaires sent to the participants. Specific aspects of disability prevention and rehabilitation were likewise extensively discussed during the seminar.

There was a general consensus on the need for immediate and concerted action to strengthen programmes for disability prevention, rehabilitation and equalization of opportunities for the remainder of the Decade and beyond.

AREAS OF CONCERN

PREVENTION

Many physical, mental and sensory impairments can be prevented. If impairments have occurred, their undesirable physical, psychological and social consequences can be minimized. Programmes of prevention should include the following measures: improvements to the educational, economic and social status of the population; introduction of early detection and intervention programmes; improvement of health service delivery, particularly primary health care systems that reach all segments of the population; expansion of programmes of immunization; passage of appropriate legislation and regulations; modification of lifestyles; control of environmental hazards; conduct of education and information campaigns related to disability prevention and rehabilitation for the public and professionals; and fostering of better informed and strengthened families and communities.

Avoidable disability causes economic waste. Development programmes that result in better primary health care, nutrition, education and housing increase the likelihood of improved disability prevention and rehabilitation.

The provision for all people of health care and related services needed to eliminate or minimize the disabling consequence of impairment is encouraged.

REHABILITATION

Detection and diagnosis of impairment should be made as early as possible so that the necessary medical care and treatment can follow in time to prevent disability or at least prevent it from escalating into more limiting secondary disabilities. In cases where prevention of disability is too late or impossible, rehabilitation services should include training in self-care activities and mobility; communication, for example sign language; social, psychological and other types of counselling and assistance. Rehabilitation should also involve provision of technical aids; special education services; and vocational rehabilitation services. The provision of rehabilitation services for persons with impairments to enable them to reach optimum physical, mental and social functional levels should be ensured.

The traditional approach to rehabilitation is institution-based. Efforts should be made to develop and strengthen community-based rehabilitation (CBR) services, as the mainstay of rehabilitation programmes. CBR has been found to be affordable, accessible and appropriate to local situations. With local government support, it could help communities and families to reinforce the efforts of their disabled members to overcome the disabling effects of impairment within their normal environment. All types and levels of services for disabled persons should be provided, whenever possible within the existing health, social, educational and labour structures. The establishment of family support systems should likewise be encouraged.

ASSISTIVE DEVICES

Many disabled persons need technical aids to improve function, mobility and independence in everyday activities or to compensate for loss of hearing or vision. As far as possible, the use of low-cost, indigenous materials in the fabrication of these devices should be encouraged. Many countries have eliminated import taxes and other obstacles that hinder accessibility to such aids and equipment. The development and production of technical aids in line with the overall technological development of countries should be supported.

EDUCATION

Although many countries offer some forms of scholarship for disabled children, most children with special needs receive neither regular, non-formal nor specialized education. People are generally unaware of the potential of disabled children and adults to benefit from education.

To the extent possible, disabled persons should be included in the general education system to ensure successful integration. Teacher training programmes covering the needs of disabled persons should be provided for regular teachers, special teachers and other members of the education support teams.

TRAINING AND EMPLOYMENT

Given proper guidance and assessment, counselling on proper work adjustment and training, disabled persons can perform a wide range of work. However, in many countries it is not easy for them to find meaningful employment. Some Member States have supported the integration of disabled persons into employment through measures, such as quota schemes and tax concessions. For disabled persons with special needs or severe disabilities, sheltered workshops have been established.

Alternative strategies to ensure more and better employment opportunities for disabled persons should be developed so that persons with disabilities could be self-reliant to the extent possible.

HUMAN RESOURCE DEVELOPMENT

Member States are aware that one of the most formidable obstacles to the development of disability prevention and rehabilitation programmes is the scarcity of trained professionals and personnel. There is also a need to improve the way institutions conduct training. Quality should be standardized across courses. Curricula should consider the socio-cultural setting of each country. Assessment should be made periodically with regard to human resource needs for training and staff development in accordance with national priorities.

Emphasis should be placed on training of trainers of field level workers. Training of community-based workers in the early detection of impairment and provision of primary assistance is particularly important. With adequate training and supervision, community workers can provide the services needed by disabled persons and help to alleviate human resource shortages.

Continuing education is particularly important for professionals supervising and training rehabilitation team members. The need for the establishment of a regional research and training centre to address the various issues of rehabilitation has been recognized and is deemed essential.

INFORMATION AND PUBLIC AWARENESS

Disabled persons are often excluded from educational, social and vocational opportunities because of the negative attitudes of non-disabled persons. Prejudice and discrimination extend to all levels of society and create psychological and social problems for many disabled persons. Sustained public education campaigns are needed to eliminate attitudinal barriers and to open the various systems of society to all disabled persons.

Public information and public education campaigns, including the use of media, should be launched to foster a broader understanding of disability-related matters among all elements of the population, including disabled persons.

SELF-HELP ORGANIZATIONS

Disabled persons throughout the world have established organizations to function as advocates for their rights. Through such organizations, disabled persons have become their own representatives, influencing government leaders, identifying their own needs, determining priorities, evaluating services and promoting public awareness. Their aim is full participation and equality.

To ensure that disabled persons have opportunities to make their views known in the planning and implementation of disability-related matters, collaboration between disabled persons' organizations and Member States should be encouraged.

ACCESSIBILITY AND COMMUNICATION

Important measures have been taken by many countries to remove or reduce barriers to equalization of opportunities. Laws have been passed to enable disabled persons to enjoy the rights to education, employment and social interaction. Many countries have taken steps to provide access to all kinds of information for people with sensory disabilities. Means of making public transportation accessible have been designed. Efforts should be intensified to achieve equal opportunities and to integrate disabled persons into society.

DATA AVAILABILITY

Many Member States do not have accurate and comprehensive data which reflect the situation of disabled persons. In particular, data on mental illness, mental retardation and disability are often lacking. Definitions of impairment, disability and handicap are not uniform. There is a need to establish a standardized database on the causes, types and incidence of disability, and the availability of resources for rehabilitation service delivery.

An efficient and reliable system of data collection which includes data on disability should be developed to help planners, policy-makers and administrators in projecting needs and priorities, and identifying programmes which should be given attention. Information access for disabled persons themselves should also be ensured. This could include the use of available and affordable information technology for various forms of disability.

RESEARCH

Most countries in the Region do not have an organized research agenda for disability prevention and rehabilitation. Studies which evaluate various rehabilitation policies and programmes, assessing their gains and costs, are greatly needed.

Recent progress in bio-medical research should be tapped to develop new tools for improving disability prevention and rehabilitation programmes. Particular efforts should be devoted to finding solutions which are appropriate to the cultural and economic conditions in developing countries. Epidemiological studies to determine the magnitude and nature of disabilities should be undertaken. The sharing and utilization of research findings should be encouraged.

LEGISLATION

Most Member States have enacted some laws to guarantee disabled persons the right to, and opportunities for, education, employment, social security, and access to community facilities. Many countries have taken important steps to eliminate or reduce barriers to full participation, removing physical and cultural barriers and eliminating discrimination against disabled persons.

Many conditions prevent disabled persons from exercising the rights and freedoms guaranteed to their fellow citizens. A comprehensive legal basis and authority for measures to promote disability prevention and rehabilitation and to support the full participation of disabled persons in the life of the community should be created through legislation.

NATIONAL COORDINATION

The concerns of disabled persons are varied and should not be treated in isolation. These concerns should be addressed taking into consideration the aspirations of persons with different types of disabilities. National bodies to coordinate the efforts of each sector, public or private, which has responsibility for specific areas concerning disabled persons--health, education, vocation and social-- should be established or strengthened. This will promote coordination in policy formulation, programme planning and implementation. This will also ensure that the system functions as a whole in the field.

REGIONAL COOPERATION

Regional cooperation should be encouraged in the field of prevention of disability, rehabilitation of disabled persons and equalization of opportunities. Arrangements should be made to intensify technical cooperation and exchange of information and experience among countries in the Region. Cooperation could be in such areas as establishing or strengthening national committees, identifying needs, collecting and analysing information and collaborating in research activities and training.

CONCLUSION

The participants of the seminar to mark the mid-point of the Asian and Pacific Decade of Disabled Persons gave their full support to the programme of work contained in the Agenda for Action. They recommended periodic evaluation of the progress made during the Decade. Such a reaffirmation of support for the Agenda for Action, which was drawn up at the beginning of the Asian and Pacific Decade of Disabled Persons, is essential to strengthen actions for the remainder of the Decade and beyond.

ACKNOWLEDGEMENT

The production of this documents would not have been made possible without the valuable support of the National Rehabilitation Center for the Disabled (NRCD), Japan, and more particularly from its President, Dr. Yasuhiro Hatsuyama, to whom we are deeply grateful.

Starting from a working draft prepared by Dr. N. V. K. Nair, Dr. Linda Milan, and Dr. Antonio Periquet, comments and views of a broad range of experts were obtained and incorporated into successive versions until the final form was reached. We would like to express our gratitude to the following experts, who graciously dedicated their precious time, knowledge and expertise to the formulation of this statement.

Amatyakul, Poonpit

Ratchasuda College, Mahidol University

Nakorn Prathom, Thailand

Asai, Kunihiko

Japan Association of Psychiatric Hospitals

Tokyo, Japan

Cabrera, Benjamin Gerardo G.

Department of Ophthalmology

Philippine General Hospital

Manila, Philippines

Chavasiri, Cholavech

Siriraj Spinal Injury Unit

Mahidol University

Bangkok, Thailand

Cammayo, Primitivo

Negros Occidental Rehabilitation Foundation, Inc.

Bacolod, Negros, Philippines

Chan, Wai Lim William

Dept. of Rehabilitation Medicine

Tan Tock Seng Hospital

Singapore

Deva, M. P.

Dept. of Psychological Medicine

Faculty of Medicine, University of Malaya

Kuala Lumpur, Malaysia

Fisher, Robert

Mental Health Program

Rockhampton District Mental Health Service

Rockhampton, Australia

Hendarmin, Hendarto

Dept. of Otolaryngology, Faculty of Medicine

University of Indonesia

Jakarta, Indonesia

Inthirat, Souphan

National Rehabilitation Center

Ministry of Public Health

Vientiane, Laos

Khan, Hasan Sayedee

National Center for Hearing and Speech for Children

Dhaka, Bangladesh

Kimura, Tetsuhiko

Hospital

National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Kikkawa, Takehiko

National Institute of Mental Health

Ichikawa, Chiba, Japan

Li, Jianjun

China Rehabilitation Research Center

Beijing, China

Lopez, Cristina S.

Hearing & Dizziness Center

Dept. of Otorhinolaryngology

Santo Tomas University Hospital

Manila, Philippines

Marshall, Ruth

Royal Adelaide Hospital

Hampstead Rehabilitation Centre

Northfield, Australia

Marques, Lino Pinto

Social Service Dept. of Macau

Dept. of Physical Medicine and Rehabilitation

Centro Hospitalar Conde de S. Januerio

Macao

Nakamura, Ryuichi

Training Center

National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Nan, Dengkun

WHO Collaborating Centre of Training & Research in Rehabilitation

Tonji Medical University

Wohan, China

Nyunt Nyunt

National Rehabilitation Hospital

Yangon, Myanmar

Omar, Zaliha

Dept. of Allied Health Science

Faculty of Medicine

University of Malaya

Kuala Lumpur, Malaysia

Park, Chang Il

Dept. of Rehabilitation Medicine

Yonsei University College of Medicine

Seoul, Korea

Sebestian, Sandiyao

Dept. of Pedagogy & Educational Psychology

Faculty of Education

University of Malaya

Kuala Lumpur, Malaysia

Shen, Yucun

Institute of Mental Health

Beijing Medical University

China

Shibata, Sadao

College

National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Simaroj, Pornchai

Dept. of Ophthalmology

Rehabilitation Hospital, Faculty of Medicine

Mahidol University, Bangkok

Thailand

Supranjono

Prof. Dr. Soeharso Orthopaedic Hospital

Surakarta, Indonesia

Tobimatsu, Yoshiko

Hospital

National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Toga, Jokatama

Fuji National Council for Disabled Persons

Nasinu, Fiji

Tjandrakusuma, Handojo

CBR Development and Training Center

Surakarta, Indonesia

Yamauchi, Shigeru

Research Institute

National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Yanashima, Kenji

Hospital, National Rehabilitation Center for the Disabled

Tokorozawa, Japan

Zhuo, Dahong

WHO Collaborating Centre for Rehabilitation

Dept. of Rehabilitation Medicine, Sun Yat-sen University of Medical Science

China