4   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2

Research

Article

UNDeRstaNDiNG the cURReNt 
DiscOURse OF RehabilitatiON: 
With ReFeReNce tO Disability 

MODels aND RehabilitatiON POlicies 
FOR evalUatiON ReseaRch iN 
the sOUth aFRicaN settiNG

Correspondence Author:
Gubela Mji
Centre for Rehabilitation Studies,
Stellenbosch University
South Africa
Email: Gumji@sun.ac.za

AbstrACt:  Evaluation of rehabilitation programmes is essential 
in order to monitor its effectiveness and relevance. There is however 
a need to consider policies when conducting evaluation research 
in rehabilitation. The aim of this paper is to present the theoretical 
and legislative underpinnings of rehabilitation in South Africa.  
A narrative review of national and international disability legislation 
and empirical research in context of rehabilitation was conducted. 
The findings of this review reveals that as a fluid construct, the 
discourse of rehabilitation has been underpinned by the changing 
theoretical and socio-political understandings of disability.  This in 
turn has influenced various international and national health and 
disability policies and legislations that oversee the implementation of 
rehabilitation practice. Despite this, there has been little evaluation 
of public health rehabilitation services in context of these policies and legislations in South Africa. The fluidity of rehabilitation 
need to be considered when conducting evaluation research in rehabilitation. 

Key words:  RehAbiliTATion, nATionAl RehAbiliTATion Policy, evAluATion, SouTh AfRicA

Mji G¹, chappell P¹, statham s2, 

Mlenzana N3, Goliath c4, DeWet c5 

and Rhoda a3

 1 Centre for Rehabilitation Studies, Stellenbosch University. 
 2 Division of Physiotherapy, Stellenbosch University.
 3 Department of Physiotherapy, University of the Western Cape.
 4 Division of Community Health, Stellenbosch University.
 5 Department of Health, Western Cape.

the 2011 Census is not comparable 
with previous data as the definition of 
disability used in the 2011 census was 
different to what was previously used. 
The definition of disability used in  
the 2011 census yielded information 
relating to the type and degree of 
disability and not overall percentage. 
According to the 2011 census report 
however, >90% of people reported 
having “no difficulty or limitation 
preventing them from carrying out 
certain functions…” (Stats SA 2011:46).

People with disabilities face various 
physical and attitudinal barriers to 
participation in their communities and 
access to vital health services (WHO, 
2011). These barriers, have led to 
national and international legislative 

iNtRODUctiON
Globally, according to the World Health 
Organisation’s (WHO) World Report 
on Disability (WHO 2011), more than  
1 billion people live with some form of 
disability. Within South Africa, current 
estimates for the number of people with 
disabilities converge at five to six percent 
of the population, equating to around 2.5 
million people (Stats SA 2001). It should 
be noted that information obtained in 

changes being brought into force in 
order to strengthen the rights of people 
with disabilities. The current guiding 
policies in South Africa are the National 
Rehabilitation Policy (NRP) of South 
Africa (DOH, 2000), the UN Convention 
for the Rights of Persons with Disabili­
ties (UNCRPD) (UN, 2011) and the 
WHO Community Based Rehabilitation 
(CBR) Guidelines (WHO, 2010). All of 
these policies and guidelines set out the 
objectives for effective and accountable 
rehabilitation services that include the 
full participation of people with disabi­
lities in the planning, monitoring and 
evaluation of services. The aim of this 
paper is to present an overview of the 
theoretical and legislative underpin­
nings of rehabilitation in South Africa 



5   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2 

in order to inform research related to the 
evaluation of research. 

the PaNOPtic Gaze OF health 
PROFessiONals aND Rehabilita-
tiON seRvices
The discourse of rehabilitation is not 
a fixed entity, but is rather a fluid 
construct that has been subject to the 
changing theoretical and socio­political 
understandings surrounding disability. 
For instance, historically, in South Africa 
rehabilitation provision within public 
health services have predominantly 
been institutionally based and focused 
on individual therapy rendered with­
in a medical model approach (Rule, 
Lorenzo, Wolmarans 2006, OSDP 1997).  
Within this medical model approach, 
the bodies of disabled people were 
perceived as incomplete and in need 
of professionals who were presumed 
to have the knowledge and ability to 
define and provide for the disabled 
body.  As depicted by Crawford (1994, 
p.1352), the [disabled] body was seen 
as ‘a composite of technical operations 
and functional capacities and provided 
the advice of experts is followed it is 
possible to alter the individual for the 
better’. Given this perspective, the 
objective of the medical model was to 
eliminate or return impaired bodies to 
societal normativity (Simmons, Black­
more & Bayloss, 2008).  In this light, 
rehabilitation has been defined as ‘a 
process aimed at enabling people with 
disabilities to reach and maintain their 
optimal functional levels by providing 
them with the tools they need to attain 
independence and self­determination’ 
(WHO, 2007).

In placing the discourse of rehabi­
litation within a Foucauldian analysis, 
the supervisory approach of the medical 
model symbolises the application of 
what Tremain defines as ‘modern panop­
ticism’, whereby the lives of people 
with disabilities are within con stant 
surveillance by health professionals 
(Treman 2005, p.84). Within this 
context, it would appear that the notion 
of power is firmly in the hands of 
health professionals whilst people with 
disabilities ultimately play a passive 
role. However, as highlighted by Michel 
Foucault (1978, p.94), power is ‘not 

for social inclusion (Albert 2004; Bury 
2005).

Bury (2005), asserts that Disabled 
People Organisations (DPOs) should 
also be recognised as key actors in 
civil society.  In doing so they are able 
to conduct dialogue and lobby political 
and social structures for the needs of 
people with disabilities in collaboration 
with other organisations. People with 
disabilities are no longer perceived 
as passive role players. In addition, it 
also outlines the fluidity of power and 
the rejection of people with disabilities 
as an invisible group to one able to 
develop new definitions and political 
form (Shakespeare 1996).  In reviewing 
the socio­political stance taken by the 
social model, it can clearly be seen that 
there is a shift in responsibility from the 
individual to society.  

Placing this in context of the discourse 
of rehabilitation, more focus is now 
given to intervening in the environ­
ment in an attempt to facilitate the full 
integration of people with disabilities 
into local communities (Chappell & 
Johanns meier 2009; Barnes & Mercer 
2005). Quintessentially, it is not so much 
the individual who needs rehabi litation, 
but rather the social and physical struc­
tures that disadvantage people with  
dis abilities. Furthermore, in recognising 
the key role of DPOs, the social model 
calls for rehabilitation professionals to 
revise their practice and share their skills 
with people with disabilities (Wirzand 
Chalker, 2002). In doing so rehabilitation 
professionals need to also recognise and 
respect the experiences and expertise of 
people with disabilities themselves.  

The social model is mainly focused 
on removing barriers, some have 
questioned whether using this approach 
would ignore the ‘real rehabilitation’ 
needs of people with disabilities such as 
mobility and other comprehensive health 
needs and special education (Thomas & 
Thomas 2002). What’s more, disability 
feminists have argued that the social 
model ignores the personal experiences 
of people with disabilities, which 
include issues surrounding the body 
such as impairment, sexuality and pain 
(Hughes & Patterson 1997).  

Discourses surrounding the dualism 
between impairment and disability have 

something acquired, seized, or shared...
it is exercised from innumerable points’.  
In view of this, just like rehabilitation, 
power is also a fluid entity and everyone 
has the potential to exercise power.  
Foucault (1978, p.95) also goes on to 
suggest that ‘where there is power, there 
is resistance’.

This notion of resistance generated 
a new kind of counter­politics. For 
instance, within the context of disability 
and rehabilitation, the rise of the 
disability rights movement and a social 
model of disability, saw the development 
of resistance towards the normative 
measures of the medical model. For 
example, during the late 1980s in South 
Africa people with disabilities began 
to rise up and challenge rehabilitation 
professionals to work with the disability 
rights movement. According to Chap­
pell and Johannsmeier (2009), one of 
the main criticisms of the medical 
model approach is that it places sole 
responsibility for change upon the 
individual and pays little attention to 
the barriers that hinder the full social 
integration of people with disabilities.  
These barriers can either be physical 
(e.g. inaccessible buildings, transport, 
lack of sign language interpreters etc.) 
or attitudinal (e.g. discrimination in the 
workplace).

sOcial cONstRUctiON OF Reha-
bilitatiON
The social model of disability therefore 
brought about a paradigm shift in how 
disability is constructed (Rule, 2006).  
In this instance, a distinction is made 
between impairment and disability.  As 
outlined by Albert (2004) and Barnes 
and Mercer (2005), disability is not only 
about health and pathology, but about 
discrimination and social exclusion, 
which is often imposed on individuals 
with impairments. Therefore, although 
not denying the need for medical inter­
vention, the social model acknowledges 
disability as a civil rights issue.  Addit­
ionally, it also advocates for the inter­
collaboration of both political and civil 
society organisations such as health, 
social development, labour and educa­
tion in raising the profile of people 
with disabilities in the disabled peo­
ple struggle against discrimination and 



6   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2

caused a major shift in the conceptua­
lisation of rehabilitation.  In recognition 
of this change, the International Classi­
fication of Functioning, Disability and 
Health (ICF) has been developed as 
a way of understanding the complex 
interaction between features of the 
biological, psychological, cultural and 
social factors of disability (WHO, 2001).  
In this model, which is also known as 
the biopsychosocial model, disability is 
defined as the outcome of the interaction 
between a person’s health condition and 
the context in which the person finds 
themselves (Scheneider 2006). This 
context includes external environmental 
factors (e.g. assistive devices, physical 
accessibility, societal attitudes), and 
those factors internal to the person (e.g. 
age, sex, coping skills, personality).  As 
elements of the body and personal and 
external environmental factors change, 
so the outcome will also change.

iNteRNatiONal aND NatiONal 
leGislatiON that iMPact ON 
RehabilitatiON seRvices
Rehabilitation services are subject 
to several national and international 
policies. The reforms of 1994 in South 
Africa and the creation of the UN 
Millennium Development Goals in 2000 
have necessitated adjustments of existing 
health policies and the development 
of new ones. The overarching aim was 
to improve access to health services 
especially to the poor and previously 
disadvantaged communities.  The rise of 
the disability rights movement and the 
social model has played an influential 
role in the enhancement of disability 
legislation and a call for change in 
the structure and implementation of 
rehabilitation services.  In South Africa 
for example, the outset of the Integrated 
National Disability Strategy (which  
was based on the UN Standard Rules 
for the equalisation of opportunities for 
persons with disabilities (UN Standard 
Rules 1994) shaped the foundation for 
the National Rehabilitation Policy (DOH 
2000).  This is clearly evident within the 
goal of the NRP, which stipulates that:
 ‘...this policy is to improve accessi­

bility to all rehabilitation services in 
order to facilitate the realisation of 
every citizen’s constitutional right to 

have access to health care services. 
This policy should also serve as a 
vehicle to bring about equalisation of 
opportunities and to enhance human 
rights for persons with disabilities, 
thereby addressing issues of poverty 
and disparate socio­economic circum­
stances (DOH 2000, p.2)

In analysing the objectives of the  
NRP critically, it can clearly be seen that 
it is resolutely based on the strategy of 
CBR, whereby people with disabilities 
should play a very active role in the 
planning, implementation and evalua­
tion of reha bilitation services. However, 
although the NRP was adopted in 2001, 
there is no empirical evidence to suggest 
that rehabilitation services have been 
implemented according to the objectives 
of the NRP.

Another recent disability legislation 
that influences the delivery of reha­
bilitation is the UN Convention for 
the Rights of Persons with Disabilities 
(2006), which South Africa ratified 
and brought into law in 2007. Based 
on the UN Standard Rules (1994), the 
Convention aims to ensure all rights and 
freedoms for all people with disabilities 
are respected and protected (Rule et 
al 2006). Although many of the fifty 
articles set out in the UNCRPD (2006) 
relate indirectly to the discourse of 
rehabilitation, five of the articles, as 
depicted in Table 1, strongly feature 
rehabilitation.

These articles give clear guidelines 
regarding how to respond to the 
rehabilitation needs of people with 
disabilities.  What’s more, these articles 
resonate with the objectives outlined in 
the NRP of South Africa.

the cONtRibUtiON OF PRiMaRy 
healthcaRe aND cOMMUNity 
baseD RehabilitatiON stRateGy 
tO the NRP
Throughout the NRP (DOH, 2000), 
places a strong emphasis on Primary 
Healthcare (PHC) and community­based 
services. Koutzky and Tollman (2008) 
point out that the transformation and 
implementation of PHC has posed an 
extreme challenge to the South African 
government. As a consequence this 
means that the premise of PHC remains 
largely unfulfilled. Further in their 
critique of PHC in South Africa, Koutzky 
and Tollman (2008) delineate a varied 
amalgam of factors that pose challenges 
on the provision of PHC. These included 
factors such as high rates of medical 
migration and severe health worker 
shortages, an imbalance in resource 
allocation, a curative­orientated health 
service and a deficiency in managerial 
capacity (Koutzky & Tollman,  2008, 
p.24). Taking this into perspective, it 
would appear that little attention and 
resources have been given to move 
rehabilitation services from policy to 
practice. What’s more, in analysing the 
issue of policy and practice critically, it  
is clear that a paradoxical relationship 
has developed, especially in relation 
to the discourse of rehabilitation. For 
example, although the NRP alludes 
to a social model, it would appear 
from Koutzky and Tollman’s (2008) 
review that in practice the normative 
and ‘curative­orientated’ service of the 
medical model is still dominantly in 
place even at primary level of care.

One of the strategies put forward 
by the NRP in relation to PHC is the 
implementation of a community based 

table 1: selected articles on rehabilitation from UN convention for the Rights of 
Persons with Disabilities

article No. topic area

9 Accessibility

19 Living independently and being 

included in the community

20 Personal mobility

25 Health

26 habilitation and rehabilitation



7   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2 

rehabilitation (CBR) framework. CBR 
has emerged as an effective strategy 
of providing rehabilitation services 
to people with disabilities and their 
families (Chappell and Johannsmeier 
2009). According to Finkenflugel and 
Rule (2008), CBR takes an inclusive 
development approach, which means 
that rehabilitation services should 
include people with disabilities in key 
mainstream development programmes 
and strategies. Within the NRP, the 
strategy of CBR has been described as 
an approach to delivering service and 
not necessarily the service itself (DoH 
2000).  

As CBR is part of community 
development, one of its key components 
is the reduction of poverty amongst 
people with disabilities. This focus 

coincides with other global initiatives 
that aim to address development and 
poverty such as The Millennium Deve­
lop ment Goals (2000).  Coleridge (2006) 
articulates that one of the first steps in 
tackling poverty is to give a voice and 
full participation to those most affected 
by poverty.  Recognising disability as a 
rights­based issue and focusing on the 
concept of equalisation of opportunities 
provides the CBR strategy with an 
appropriate platform in which to address 
poverty alleviation.

In accordance with the CBR Guide­
lines (WHO, 2010), the strategy of 
CBR is composed of five topic areas, 
which are health, education, livelihoods, 
social and empowerment. As depicted 
in Table 2, each of these topic areas 
have five key elements, which inform 

the implementation of CBR.  According 
to the CBR Guidelines (WHO 2010), 
programmes may not necessarily 
address all elements in the matrix, but 
only address some of the topic areas 
and its elements depending on local 
circumstances.

According to Bury (2005), there are a 
number of community­orientated reha­
bilitation programmes that claim to be a 
CBR programme.  One such approach is 
the use of outreach.  Bury (2005, p.42) 
describes outreach as ‘programmes run 
by health care workers at a local level to 
provide complex professional care which 
directly addresses patients’ pathology, 
impairments and / or disabilities’.  As 
denoted by Rule et al (2006) CBR is 
a process of empowerment in which 
people with disabilities and their com­
munities participate in a process that 
leads to decisions by and for themselves.  
Building on this premise, the whole 
strategy of CBR is underpinned by 
the CBR principles of participation, 
inclusion, sustainability and self­advo­
cacy as illustrated in Table 3. 

In analysing the principles of CBR, 
it’s clear to see how they coincide with 
both the UNCRPD (UN 2006) and the 
objectives of the NRP (DOH, 2000).  
Quintessentially, given the notion put 
forward by the NRP (DOH, 2000, p.6) 
that CBR is an ‘approach’ to service 
delivery, the principles of CBR (as 
described in Table 3) should therefore  
be applied to all levels of rehabilitation 
to ensure they are in alignment with  
both the NRP and UNCRPD.  

evalUatiON OF RehabilitatiON 
seRvices
Evaluation of rehabilitation programmes 
is essential in order to monitor its 
effectiveness and relevance. This is 
reiterated within the objectives of the 
NRP (DOH, 2000) and in Article 31 
of the UNCRPD (UN, 2006). Hartley 
(2002) also articulates that without 
evaluation the impact of rehabilitation 
is not confirmed, which in turn could 
affect the sustainability of a pro­
gramme.  To help guide the evaluation 
of rehabilitation programmes, Jonsson 
(cited in Mannan & Turnball, 2007) 
and Velema and Cornielje (2003) make 
a distinction between two evaluation 

table 3: Principles of cbR (WhO 2010)

cbR PRiNciPles DeFiNitiON

Participation Active contribution of people with disabilities 

in CBR practice and monitoring

Inclusion Placing people with disabilities and their issues 

in the mainstream

Sustainability Benefits of the programme must be lasting beyond 

life of programme

Self-advocacy Consistent involvement of service users in terms of 

defining practice & indicators

table 2: cbR Matrix (WhO 2010)

cbR MatRiX

health sOcialeDUcatiON livelihOOD

PROMOtiON

PReveNtiON

MeDical caRe

RehabilitatiON

assistive
Devices

eaRly
chilDhOOD

PRiMaRy

secONDaRy 
& hiGheR

NON-FORMal

liFe-lONG
leaRNiNG

sKills
DevelOPMeNt

selF-
eMPlOyMeNt

FiNaNcial
seRvices

WaGe
eMPlOyMeNt

sOcial
PROtectiON

RelatiONshiPs
MaRRiaGe &

FaMily

PeRsONal
assistaNce

cUltURe &
aRts

RecReatiON
leisURe & 

sPORts

access tO
JUstice

cOMMUNica-
tiON

sOcial
MObilizatiON

POlitical
PaRticiPatiON

selF-helP
GROUPs

DisableD
PeOPle’s

ORGaNizatiONs

eMPOWeRMeNt



8   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2

models, which are individual and pro­
gramme evaluations.  

Through reviewing the literature, 
it appears that the majority of rehabi­
litation evaluations tend to use an 
individual model and have a tendency 
to focus on changes in activities of 
daily living (ADL), quality of life and 
vocational abilities of people with 
disabilities. For instance, Lagerkvist 
(2003) conducted an evaluation study 
of two CBR programmes in the Philip­
pines and Zimbabwe. Through taking 
case histories and testing ADL ability 
amongst 206 people with disabilities 
it was found that there was a 78% ­ 
93% gain in abilities following CBR 
intervention. Likewise, in using struc­
tured interviews with 77 people with 
disabilities in Botswana, Lundgren­
Lindquist and Nordholm (1999) found 
most people had maintained high levels 
of independence in ADL. Furthermore, 
20% of adults were working as a result 
of rehabilitation intervention. 

Although the individual evaluation 
model provides knowledge on the 
effectiveness of professionally­driven 
rehabilitation intervention, there is no 
indication of the levels of participation 
or self­advocacy achieved by people 
with disabilities in the service given 
the principles of CBR as mentioned 
earlier. The uses of programme evalua­
tions however, are more wide­ranging 
and involve overall aspects such as 
efficiency, relevance, impact and sus­
tainability of a programme (Mannan 
& Turnball 2007). In addition, Velema 
and Cornielje (2003, p.1252) suggest 
that programme evaluations should also 
address environmental issues such as 
the extent to which the programme is 
a learning organisation, the ‘resources 
available to people with disabilities, 
the inclusiveness of education and 
employment and a number of eco­
social variables e.g. housing, sanitation, 
transport etc’. In reviewing the lite­
rature, of the few studies that used 
programme evaluation, most of them 
were CBR evaluations. For example, 
Sharma and Deepak (2001) used a parti­
cipatory approach to evaluate a CBR 
programme in North Central Vietnam.  
In using a SWOT Analysis (strengths, 
weaknesses, opportunities and threats), 

they carried out six focus groups and 
eleven semi­structured interviews with 
people with disabilities and a few CBR 
workers.  

Within context of South Africa, a 
national audit on disability research 
found that there was very little empi­
rical evidence that has evaluated rehabi­
litation services (McLaren et al,  2006).  
Of those that have been completed, 
they have mostly focused on CBR 
programmes, in particular the role of 
CBR Workers. For example, Concha 
(2001) completed an evaluation study, 
which looked at the value of CBR 
Workers on people with disabilities 
living in rural communities in Limpopo.  
Using a mixed­method design, the study 
examined the number and types of 
clients seen by the CBR Workers, their 
effectiveness and the perceptions of the 
CBR Workers regarding the value of 
their work.  A similar study conducted by 
Chappell and Johannsmeier (2009) also 
used a mixed­method design to eva luate 
the impact of Community Rehabilitation 
Facilitators (CRFs) working in six of 
the provinces in South Africa. The study 
highlighted both the impact and gaps in 
CRFs work with people with disabilities, 
their families, groups and communities.

In relation to evaluation of rehabi­
litation within institutions, it was found 
that although some studies evaluated the 
impact of interventions on people with 
disabilities (Kahonde et al, 2010) or 
improvements in quality of life (Jelsma, 
2007); very few have actually evaluated 
the attitude or structure of public health 
rehabilitation services. In addition, there 
is also a lack of empirical evidence 
that has explored how institutional 
rehabilitation services have either 
included people with disabilities in 
evaluating services or how the services 
have placed issues of disability in the 
mainstream.  This lack of evidence may 
coincide with Koutzky and Tollman’s 
(2008) previous analysis that healthcare 
in South Africa still resides in a medical 
model approach whereby people with 
disabilities still play a passive role.  

Rehabilitation is thus seen as a matter 
of situated and lived interaction of 
people with their social and physical 
environment. Hence, according to 
Schwandt (2003, p.94) evaluation must 

‘not be cast in exclusively instrumentalist 
terms, but rather continuously try and 
grasp the lived reality by being with or in 
relation to the activities one evaluates’.    

cONclUsiON
The discourse of rehabilitation is both 
a complex and fluid entity that has 
been subject not only to the changing 
theoretical underpinnings of disability 
theory, but also international and 
national policy and legislation. This has 
in turn influenced various international 
and national health and disability 
policies such as the NRP that oversee 
the implementation of rehabilitation 
practice. Despite this, there has been 
little evaluation of public health reha­
bilitation services in the context of these 
policies and legislations in South Africa.  
This review highlights the need for 
recognising the fluidity of rehabilitation 
during evaluation research. It suggests 
that rehabilitation as a fluid construct 
has to respond to the changing socio­ 
political discourse that impacts on the 
lives of disabled people. 

acKNOWleDGeMeNts
Project funder: The South Africa Nether­
lands Research Programme on Alter­
natives for Development (SANPAD)

Members of the research team:  Handri 
Liebenberg, Rochelle Felix, Conran 
Joseph, Anne Kumurenzi, Maatje 
Kloppers and Siphokazi Gcaza. 

Research advisors: Professor Marietjie 
Devilliers, Mr Huib Corneljie, Professor 
Arnie Eide, Ms Blanche Pretorius and 
Ms Catherine Collingwood.

ReFeReNces

Albert B 2004. The social model of disability, 
human rights and development. Disability 
Knowledge and Research. Electronic Citation. 
http://www.handicap­international.fr/biblio­
graphiehandicap/1Handicap/ModelesCompre­
hension/socialModel.pdf. Last accessed March 
2012

Barnes C, Mercer G 2005 Understanding impair­
ment and disability: towards an international 
perspective. In Barnes, C. & Mercer, G. (Eds.) The 
Social Model of Disability and the Majority World. 
University Press, Leeds 



9   SA JournAl of PhySiotherAPy 2013 Vol 69 no 2 

Bury T 2005 Primary Health Care and community 
based rehabilitation: implications for physical 
therapy. Asia Pacific Disability Rehabilitation 
Journal 16 (2): 29­61

Chappell P, Johannsmeier C 2009 The impact of 
CBR as implemented by Community 

Rehabilitation Facilitators on people with 
disabilities, their families and communities in 
South Africa.  Disability and Rehabilitation Journal 
31(1): 7­18

Crawford R 1994 The boundaries of the self and 
the unhealthy other: reflections on health, culture 
and AIDS. Social Science and Medicine; 38 (10): 
1347­1365

Coleridge P 2006 CBR as part of Community 
Development and Poverty Reduction. In Hartley S 
Editor. CBR as part of community development: 
A poverty reduction strategy.  London: University 
College London, Centre for International Child 
Health 

Concha M 2009 The value of the serviced offered 
by the Community Rehabilitation Worker.  South 
African Journal of Occupational Therapy. 39(2): 
10­18.

 Finkenflugel H, Rule S 2008 Integrating 
community­based rehabilitation and leprosy 
rehabilitation services into an inclusive develop­
ment approach. Leprosy Review 79: 83­91

Foucault, M. The history of sexuality Vol. 1: 
An introduction, trans. Robert Hurley, Harmonds­
worth: Penguin; 1978

Hartley S CBR 2002 A participatory strategy in 
Africa. London: University College London 

Hughes B, Patterson K 2007 The social model of 
disability and the disappearing body: Towards a 
sociology of impairment. Disability and Society; 
1997, 12 (3): 325­340

Jelsma, J. The determinants of health­related 
quality of life in urban and rural isi­Xhosa speak­
ing people with disabilities. International Journal 
of Rehabilitation Research; 30 (2): 119­126

Kahonde CK, Mlenzana N, Rhoda 2010 A 
Persons with physical disabilities’ experiences 
of rehabilitation services at Community 
Health Centres in Cape Town.  SA Journal of 
Physiotherapy; 66 (2): 1—6

Kautzky K, Tollman S 2008 A perspective on 
Primary Health Care in South Africa. In Health 
Systems Trust. Editors. South African Health 
Review; Health Systems Trust: Durban 

Lagerkvist B 1992 Community­based rehabi­
litation­ outcome for the disabled in the Philippines 
and Zimbabwe. Disability and Rehabilitation;  
14 (1): 44­50 

Lundgren­Lindquist B, Nordholm LA 1999 
Community­based rehabilitation in Moshupu 
village, Botswana.  Disability and Rehabilitation; 
21: 10­1 

Mannan H, Turnball AP 2007A review of 
community based rehabilitation evaluations: 
qua lity of life as an outcome measure for future 
evaluations Asia Pacific Disability Rehabilitation 
Journal;18 (1): 29­45 

McLaren P, Philpott S, Chappell P, Roberts A  
2006 A national audit of disability research 
undertaken in South Africa 1994 – 2005. 
Unpublished Report. Department of Social 
Development; Pretoria

Republic of South Africa. Department of Health 
2007 Comprehensive service plan for the 
implementation of Healthcare Internet.. Electronic 
Citation. www.westerncape.gov.za/Text/2007/7/
may15,2007­csp_2.pdf. Last accessed March 2012

Republic of South Africa, Department of Health 
2000 Rehabilitation for all: National Rehabili­
tation Policy. Pretoria: Government Printers;.

Office of the Status of Disabled People 1997 
Integrated National Disability Strategy: White 
Paper; Government Printers: Pretoria Republic of 
South Africa.

Rule S, Lorenzo T, Wolmarans M 2006 
Community Based Rehabilitation: new challenges. 
In Watermeyer, B. et al, Editor. Disability and 
social change: a South African agenda. HSRC: 
Cape Town 

Shakespeare T 1996 Disability, identity and 
difference. In Barnes, C. and Mercer, G. Editors. 
Exploring the divide. The Disability Press; Leeds

Schneider M 2006 Disability and the environment 
In B. Watermeyer et al. Editors. Disability and 
social change: a South African agenda, Cape 
Town: HSRC; 

Schwandt T 2003 Notes on Evaluating the Ecology 
of Rehabilitation Praxis. Scandinavian Journal of 
Disability Research; 5 (1): 93­105

Sharma M, Deepak S 2001 A participatory 
evaluation of community­based rehabilitation pro­
gramme in North Central Vietnam.  Disability and 
Rehabilitation; 23 (8): 352­358

Simmons B. Blackmore T, Bayliss P 2008 
Postmodern synergistic knowledge creation: 
extending the boundaries of disability studies. 
Disability and Society, 23 (7): 733­745

Statictics South Africa (Stats SA) 2011Census in 
Brief. Internet. Electronic Citation http://www.
statssa.gov.za.Accessed April 2013 

Statistics South Africa (Stats SA) 2001 Census 
in Brief. Internet. Electronic Citation http://www.
statssa.gov.za. Last accessed March 2012

Thomas M, Thomas MJ 2002 Some controversies 
in community based rehabilitation. In Hartley, S. 
Editors. CBR: A participatory strategy in Africa. 
London: University College London 

Tremain S 2005 Foucault and the government of 
disability. Michigan: University of Michigan Press 

United Nations 2006 Convention on the Rights 
of Persons with Disabilities  Internet.  Electronic 
Citation www.un.org/esa/socdev/enable/rights/
convtexte.htm. Last accessed October 2011

United Nations. Millennium Development Goals 
2000 Internet. Electronic Citation. www.un.org/
millennium/declaration/ares552e.htm. Last 
accessed October, 2011

United Nations. Standard Rules for the 
Equalisation of Opportunities for Persons with 
Disabilities 1994.  UN Press: New York 

Velema J, Cornilje H 2003 Reflect before you 
act: providing structure to the evaluation of 
rehabilitation programmes. Disability and Rehabi­
litation 25 (22): 1252­1264

Wirz S, Chalker P 2002 Training issues in 
Community Based Rehabilitation in South Asia.  
Asia Pacific Disability Rehabilitation Journal; 
Series 2, January: 111­127

World Health Organisation 2011 World report on 
disability. WHO Press: Geneva 

World Health Organisation 2001 International 
Classification of Functioning, Disability and 
Health. Internet. Electronic Citation.  

World Health Organisation 2010 Community 
Based Rehabilitation Guidelines. WHO Press: 
Geneva

World Health Organisation 2007 Health Topics. 
Internet. Electronic Citation. http://www.who.int/
topics/rehabilitation/en/. Last accessed February 
2012