NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Khasnabis C, Heinicke Motsch K, Achu K, et al., editors. Community-Based Rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010.
Education is about all people being able to learn what they need and want throughout their lives, according to their potential. It includes “learning to know, to do, to live together and to be” (1). Education takes place in the family, the community, schools and institutions, and in society as a whole. The universal right to education is firmly established in international instruments that have global endorsement: the Universal Declaration of Human Rights, Article 26 (2), and the Convention on the Rights of the Child, Article 28 (3).
While international instruments state that primary education should be free and compulsory for all children without discrimination, it is widely accepted that in practice this is not happening, hence recent agreements have emphasized the need to:
expand and improve early childhood care and education; achieve free, compulsory and quality primary education for all;ensure equal access to appropriate learning, life skills programmes and basic and continuing education for all adults;
promote gender equality; facilitate inclusion of marginalized, vulnerable and discriminated groups at all levels.The Convention on the Rights of Persons with Disabilities (4) reaffirms the rights discussed above and is the first legally binding instrument to state specifically the right to inclusive education: States Parties shall ensure an “inclusive education system at all levels” (Article 24, para. 1), and States Parties should also ensure that “effective individualized support measures are provided in environments that maximize academic and social development, consistent with the goal of full inclusion” (Article 24, para. 2(e)). This includes the learning of Braille, sign language, various modes, means and formats of communication, and orientation and mobility skills.
Poverty, marginalization and discrimination are the main barriers to inclusive education (5). It is estimated by the United Nations Educational, Scientific and Cultural Organization (UNESCO) that over 90% of children with disabilities in low-income countries do not attend school; and an estimated 30% of the world's street children live with disabilities. For adults with disabilities, the literacy rate is as low as 3%, even as low as 1 % for women with disabilities in some countries (6).
From these figures, it is evident that steps must be taken to ensure access to education for all children with disabilities. The Millennium Development Goals (7) rightly identify in Goal 2, the achievement of universal primary education. The target is for children everywhere, boys and girls alike, to be able to complete a full course of primary schooling by 2015. This applies equally to children with disabilities, and hence community-based rehabilitation (CBR) needs to contribute to achieving this target.
In Mongolia, a national inclusive education programme is developing through collaboration between the Government, a parents' association, international nongovernmental organizations and European Union donors. Prior to 1989, Mongolia provided special schools and residential care for children and adults with disabilities. This system addressed basic needs, but deprived people with disabilities of other rights such as inclusion in society. After political and economic changes forced the closure of these special schools and institutions, the ground was cleared for a new approach. In 1998, with support from an international nongovernmental organization, the Association of Parents with Disabled Children (APDC) was founded to protect the rights of children with disabilities. APDC has carried out the following activities: policy review, training workshops on inclusive education in order to learn from other countries, working with the Ministry of Education to reform its policy and practice, and identifying the various support services needed to enable children with disabilities to be included in education. Community-based rehabilitation was seen to be integral to the overall strategy of promoting and protecting the rights of children with disabilities. In 2003, an Inclusive Education Unit was established within the Ministry of Education and a programme implementing committee was established in collaboration with the Ministries of Health and Social Welfare and Labour. Services for early identification, medical treatment and rehabilitation were established in local community-based centres. Initially priority was given to inclusive education at preschool level, and this has now been extended to primary schools. Over 1000 children with disabilities are included in kindergartens and teachers are trained to work inclusively. APDC continues to grow and network with other groups nationally and internationally to promote the rights of children.
People with disabilities access education and lifelong learning, leading to fulfilment of potential, a sense of dignity and self-worth, and effective participation in society.
The role of CBR is to work with the education sector to help make education inclusive at all levels, and to facilitate access to education and lifelong learning for people with disabilities.
All persons with disabilities have access to learning and resources that meet their needs and respect their rights.
Local schools take in all children, including children with disabilities, so they can learn and play alongside their peers.
Local schools are accessible and welcoming; they have a flexible curriculum, teachers who are trained and supported, good links with families and the community, and adequate water and sanitation facilities.
People with disabilities are involved in education as role-models, decision-makers and contributors. Home environments encourage and support learning.Communities are aware that people with disabilities can learn, and provide support and encouragement.
There is good collaboration between the health, education, social and other sectors.There is systematic advocacy at all levels to make national policies comprehensive to facilitate inclusive education.
A school may have an accessible building and teachers who are trained to work with all types of children, but children with disabilities may still be excluded. They may be hidden in back rooms at home, the family may lack support, and they may need assistive devices and medical rehabilitation. CBR can address all these issues and liaise between the education, health and social sectors and with disabled people's organizations. CBR personnel may need to have several rounds of discussions to convince parents about the need for and benefit of educating their disabled child, especially if the child is a girl or the parents are not educated themselves.
Education is much broader than schooling. Schooling is important, but needs to be seen in the context of a lifelong learning process. Education starts at birth in the home, and continues throughout adult life; it includes formal, informal, non-formal, home-based, community and government initiatives. These terms can be confusing and tend to mean different things in different cultures and contexts. In general: “formal education” refers to education that takes place in recognized institutions, e.g. schools, colleges and universities, often leading to recognized qualifications and certifications; “non-formal education” refers to organized educational activity outside the formal system; “informal education” refers to all the learning that happens throughout life as a whole – from family, friends and communities – which is often not organized, unlike both formal and non-formal education.
Although everyone has the right to education, sometimes it is wrongly assumed that people with disabilities are an exception. Family members, communities and even people with disabilities themselves are often unaware that they have an equal right to education. CBR programmes, working with disabled people's organizations, can support the empowerment of people with disabilities by ensuring access to information on the different rights that relate to education. This can help in lobbying authorities who have a legal obligation to provide education for all. The right to education needs to be understood in the context of a rights-based approach to development. Rights are also meant to be addressed as a whole, not in isolation (see Introduction: Human rights).
The links between poverty, disability and education mean that a community development approach is essential. “Lack of adequate education remains the key risk factor for poverty and exclusion for all children, both with and without disabilities. For children with disabilities, however, the risk of poverty due to lack of education may be even higher than for children without disabilities. Children with disabilities who are excluded from education are virtually certain to be long-term, lifelong poor”(8). Poor people may also face difficulties in educating their children with disabilities when fees are required to access education. Even where education is promoted as free, additional payments may be needed for school books, uniforms, transport and assistive devices. So children with disabilities from poor families continue not to be educated, and the cycle of poverty goes on.
The social model of disability moves away from an individual-impairment-based view of disability and focuses on removing barriers in society to ensure people with disabilities are given the same opportunity to exercise their rights on an equal basis with all others. Similarly, inclusive education focuses on changing the system to fit the student rather than changing the student to fit the system. This shift in understanding towards inclusive education is required of CBR programmes, which in the past have tended to work at a more individual level (see Introduction: Evolution of the concept).
A CBR programme has worked hard to make a young girl ready for the local school. Once at school, she struggles to move around an inaccessible school building and is constantly teased by other children. Eventually her teachers encourage her family to stop sending her to school because she is not coping. An inclusive approach would focus on the school and on removing barriers to this young girl's participation, e.g. helping it to become more accessible, preparing teachers, creating a welcoming environment and educating all children to be inclusive and supportive. If children with disabilities experience problems at school, then schools, families and CBR programmes need to start by discovering the obstacles to participation.
Inclusive education is “a process of addressing and responding to the diversity of needs of all learners through increasing participation in learning, cultures and communities, and reducing exclusion within and from education” (9). Inclusive education:
is broader than formal schooling – it includes the home, the community, non-formal and informal systems;
is based on the acknowledgement that all children can learn; enables education structures, systems and methodologies to meet the needs of all children;is based on acknowledgment of and respect for the differences between children, e.g. in age, gender, ethnicity, faith/religion, language, disability, health status;
promotes participatory, accessible and inclusive monitoring and assessment procedures; is a dynamic process which is constantly evolving according to culture and context; is part of a wider strategy to promote an inclusive society.CBR programmes should consider:
including home-based education and sign language groups for deaf children and/or adults, as inclusive education is broader than schooling;
that inclusive education is about including everyone, not just including people with disabilities. It is about making particular efforts to identify anyone who is excluded or marginalized.
Although the term “integrated education” is sometimes used in the same way as “inclusive education”, the two terms have different meanings. Integrated education refers to the process of bringing children with disabilities into the mainstream school, and placing most of the focus on the individual rather than on the school system. The disadvantage of this approach is that, if there is a problem, it is seen as the fault of the child. The impact and sustainability of the approach are also limited, with success dependent on the goodwill of one teacher or the efforts of CBR personnel, rather than on school policy or community support.
“Special education” is a broad term which can refer to the provision of extra assistance, adapted programmes, learning environments or specialized equipment, materials or methods (e.g. Braille, audio devices, assistive devices, sign language) to support children in accessing education. The term “special educational needs” is used to refer to the learning needs of any child who might have difficulties with learning – therefore special education is not only for a person with a disability.
There are a variety of ways in which special education can be delivered to children with special educational needs. Very often, children with a lot of support needs attend special schools that are segregated from mainstream schools. Although the CBR guidelines emphasize inclusive education, “special schools” are a reality for many children and families – in certain situations, they may be the only education option available for children who are deaf, blind, or deafblind, or who have an intellectual impairment. In low-income countries, these special schools are often residential, and children usually live away from their families and communities.
Unfortunately, over time, the term “special” has been used in ways that are not helpful for the promotion of inclusive education. For example, the term “special-needs child” is vague and is often used to refer to any child with a disability, regardless of whether they have learning difficulties. Care must be taken when using the term “special” as it separates children with disabilities from others. It is important to remember that all children learn in different ways, and may find learning easy or difficult at different times in their lives. To say that children with disabilities have “special” learning needs is not helpful, because it is not specific, and labels them. Children without a disability can also experience difficulties in learning, and can be excluded and marginalized within educational settings. With good teaching techniques, essential resources and an inclusive environment, all children can learn.
CBR personnel need to be aware of gender issues in relation to education. Some examples are given below.
Girls may miss out on educational opportunities in situations where they are required to care for a family member with a disability.
In some situations, boys may miss out on schooling because of the pressure to earn money to support their family.
In Hazaribagh, northern India, Rupa Kumari cares for a whole family because her mother has mental illness, her father is dead, and she has a younger brother and sister. To avoid missing out on her education, Rupa takes her very young sister to school with her, and even though class sizes are very big and the teachers complained, Rupa managed to convince them that, for her to continue to study, she must bring her younger sibling with her.
In conflict situations, boys may be recruited as child soldiers and therefore miss out on schooling opportunities. At least 5% of these boys become disabled (10), and on return from conflict are often too old to attend primary school.
CBR personnel may expect the mother and/or other female relatives of a person with disability to take on a teaching role, often increasing an already heavy workload.
Families and communities often do not prioritize education for girls and women with disabilities, who therefore experience double discrimination.
Girls, particularly girls with disabilities, are more likely to drop out of school owing to a lack of suitable toilet facilities and a safe environment.
The role of fathers is important and often ignored; a father can be a good role-model and support education if encouraged by the CBR programme.
In Lesotho, fewer boys are enrolled in primary schools, and boys drop out sooner than girls, because boys are required for herding and traditional initiation rites.
In each element considered below, there are concepts and areas of suggested activities that are common to all aspects of education. Different aspects are emphasized and different examples given in each element, so it may be useful for you to read the whole component, even if you are focusing on one particular element.
This term refers to education from birth until the start of formal primary education. It takes place in formal, non-formal and informal settings, and focuses on child survival, development and learning – including health, nutrition and hygiene. This period is often further divided into the following age ranges: birth to three years, and three years to six, seven or eight years, when formal schooling starts. In this element, the focus is mainly on children aged three years and older.
This is the first stage of schooling, intended to be free and compulsory for all children. It is the focus of the Education for All initiative proposed by UNESCO (11), and the target of most educational funding. Children with disabilities, like other children, need to be included in local primary schools so that they learn and play alongside their peers.
This is formal education beyond the “compulsory” level. For young people with disabilities, further education can be a gateway to a productive and fulfilled life, yet they are often excluded.
This includes a wide range of educational initiatives in the community: home-based learning, government schemes and community initiatives. It tends to be targeted at specific disadvantaged groups and has specific objectives. For some learners, non-formal education can be more flexible and effective than the formal education system, which may be too rigid and seen as failing to provide quality education for all. But non-formal education should be complementary, not seen as a substitute for an inclusive formal system. Sometimes non-formal education is inappropriately offered as a “second best” option for children with disabilities, denying them their legal right to formal education. In this element, the focus is on non-formal education for children rather than adults.
This includes all the learning that takes place throughout life, in particular those learning opportunities for adults not covered in the other elements. It refers to the knowledge and skills needed for employment, adult literacy, and all types of learning that promotes personal development and participation in society. In this element, the focus is on adults, rather than children.
“States are to ensure equal access to primary and secondary education, vocational training, adult education and lifelong learning. Education is to employ the appropriate materials, techniques and forms of communication. Pupils with support needs are to receive support measures, and pupils who are blind, deaf and deafblind are to receive their education in the most appropriate modes of communication from teachers who are fluent in sign language and Braille. Education of persons with disabilities must foster their participation in society, their sense of dignity and self worth and the development of their personality, abilities and creativity.” (12)
Copyright © World Health Organization 2010.All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).
