The workshop therefore recommends that detailed needs assessments, such as surveys should be undertaken in not too large, well-defined areas, where rehabilitation services can subsequently be offered or facilitated.
1.8 The one to define the (nature of the ) need for rehabilitation should be the affected person him/herself. Experience has shown that the most successful rehabilitation programmes are those where people assess there own needs. A study in Ethiopia found that of people affected by leprosy only 20% identified themselves as needing rehabilitation. The workshop noted the need to raise awareness of rehabilitation opportunities among the target population, so that they could take well-informed decisions about their needs. Reaching those most in need may be the most difficult, for reasons such as lack of motivation.
1.9 Rehabilitation requires a process of understanding, which may need a process of growih in the affected people, before they are ready to participate. Motivation by (good) example is a powerful tool in this context. People who have initially rejected rehabilitation should also be given a chance to change their minds.
1.10 From the point of view of the affected person, their needs are physical, social, mental and spiritual. Our rehabilitation approach should therefore be holistic instead of com partuentalised.
2. Implementation of rehabilitation
2.1 Governments and organisations need to be stimulated/motivated at different levels to promote rehabilitation. This should be done with a multisectoral approach. Possibilities include the setting up of a multisectoral steering committee at the national level (eg. Ethiopia) or decentralising to more peripheral development programmes (eg. Sri Lanka) . In the experience of AIFO, achieving this at the district or provincial level is easier than at the national level. Each country or project needs to see which approach would be the most appropriate/effective in their situation.
2.2 The workshop noted the problem that people affected by leprosy needing rehabilitation are often spread out over a large geographical area. Modified CBR approaches may therefore be needed to address their needs.
2.3 Where services or infrastructure for leprosy work are established, there is a great potential for 'reverse integration' in relation to rehabilitation. General CBR services could be set up around existing leprosy services.
2.4 The workshop emphasised the importance of referral and support systems for rehabilitation without which CBR programmes cannot function. A network of available rehabilitation and referral facilities should be created.
2.5 Centres like ALERT could function as regional focal points for training and collection of experience and information and could serve as resource centres on rehabilitation.
2.6 The workshop recommends that leprosy workers should take advantage of documents such as 'The Standard Rules for Equalization of Opportunities for Persons with Disabilities" by the UN (1994) . These should be studied to see how they would apply in the national or local situation, regarding people affected by leprosy.
