title: Determining the competences of community based workers for disability-inclusive development in rural areas of South Africa, Botswana and Malawi.
abstract: BACKGROUND
  Persons with disabilities and their families still live with stigma and a high degree of social exclusion especially in rural areas, which are often poorly resourced and serviced. Community-based workers in health and social development are in an ideal position to assist in providing critical support for some of those most at risk of neglect in these areas. This article analyses the work of community disability workers (CDWs) in three southern African countries to demonstrate the competencies that these workers acquired to make a contribution to social justice for persons with disabilities and their families. It points to some gaps and then argues that these competencies should be consolidated and strengthened in curricula, training and policy. The article explores local experiences and practices of CDWs so as to understand and demonstrate their professional competencies and capacity to deliver disability-inclusive services in rural areas, ways that make all information, activities and programs offered accessible and available to persons with disabilities.
  
  
  METHODS
  A qualitative interpretive approach was adopted, informed by a life history approach. Purposive sampling was used to select 16 CDWs who had at least 5 years experience of disability-related work in a rural area. In-depth interviews with CDWs were conducted by postgraduate students in Disability Studies. An inductive and interpretative phenomenological approach was used to analyse data.
  
  
  RESULTS
  Three main themes with sub-categories emerged demonstrating the competencies of CDWs. First, integrated management of health conditions and impairments within a family focus comprised 'focus on the functional abilities' and 'communication, information gathering and sharing'. Second, negotiating for disability-inclusive community development included four sub-categories, namely 'mobilising families and community leaders', 'finding local solutions with local resources', 'negotiating retention and transitions through the education system' and 'promoting participation in economic activities'. Third, coordinated and efficient intersectoral management systems involved 'gaining community and professional recognition' and the ability to coordinate efforts ('it's not a one-man show'). The CDWs spoke of their commitment to fighting the inequities and social injustices that persons with disabilities experienced. They facilitate change and manage the multiple transitions experienced by the families at different stages of the disabled person's development.
  
  
  CONCLUSIONS
  Disability-inclusive development embraces a philosophy of social inclusion and a set of values that seeks to protect the human dignity and rights of persons with disabilities. It requires a workforce equipped with skills to work intersectorally and in a cross-disciplinary manner in order to operationalise the community-based rehabilitation guidelines that are designed to promote delivery of services in remote and rural areas. CDWs potentially have a unique set of competencies that enables them to facilitate disability-inclusive community development in rural areas. The themes reveal how the CDWs contribute to building relationships that restore the humanity and dignity of persons with disabilities in their family and community. These competencies draw from different disciplines which necessitates recognition of the CDWs as a cross-disciplinary profession.
authors.affiliation: Disability Studies Division, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa. theresa.lorenzo@uct.ac.za.
authors.forename: Theresa
authors.initials: T
authors.lastname: Lorenzo
authors.affiliation: Centre for Higher Education Development, University of Cape Town, Cape Town, Western Cape, South Africa. ermien.vanpletzen@uct.ac.za.
authors.forename: Ermien
authors.initials: E
authors.lastname: van Pletzen
authors.affiliation: Department of Social Development, University of Cape Town, Cape Town, Western Cape, South Africa. margaret.booyens@uct.ac.za.
authors.forename: Margaret
authors.initials: M
authors.lastname: Booyens
mesh_terms: D000328:Adult; D001902:Botswana; D057191:Capacity Building / Q000379:methods; D003150:Community Health Workers / Q000523:psychology*; D055812:Community-Based Participatory Research; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000193:education / Q000534:rehabilitation*; D004503:Education, Medical, Graduate; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010344:Patient Advocacy; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D018794:Problem-Based Learning; D011361:Professional Competence / Q000592:standards*; D012424:Rural Population; D013019:South Africa
keywords: Accreditation/Standards; Africa; Allied Health; Asia; Assessment; Australia/Pacific; Community Participation; Determinants of Health; Education; Europe; Evidence-based Care; Health Needs Assessment; Health Promotion; Health Service reform; Human Rights and Ethics; Indigenous Health Worker; Management/Administration; Mental Health; Middle East; Primary Health Care; Professional conduct; Public Health; Qualitative Research; Rehabilitation; South America; Undergraduate; Workforce; Youth