Interview: Dr Federico Montero, PHD, Coordinator of the Disability and Rehabilitation Team (DAR) in WHO's Department of Injuries

Garance Upham

15 March 2007
Dr Montero attended the PHM's People's Health Assembly 2 in Cuenca.
He just left the WHO to return to work in Costa Rica. He has agreed to be a co-convenor of the PHM's Disability and Economics Circle. Dr Montero is a PWD himself.

Q: What is the first Human Right for people with a disability (PWD)?
Dr Federico Montero: From my experience in WHO, and the very important United Nations Convention on the Rights of Persons with Disabilities, I would say that health is the priority for disabled people internationally, if health is properly understood as a concept.
Sometimes Disabled People Organizations (DPOs) have a misunderstanding of the holistic and comprehensive concept of health and in many occasions health is minimised or reduced to medicines. So what happens is that because of the promotion of disability as not being a medical issue - and I agree totally because disability is not a disease – people sometimes get mislead into thinking that disability has nothing to do with health, while in fact it has everything to do with it.
People with disabilities in developing countries have no access to health or to rehabilitation services! As former U.N. Human Rights Commissioner Mary Robinson stated when she referred to health as the most fundamental human right, health is what can make the difference in the quality of life of anyone in the world. So, for me, being in WHO and having had the opportunity of learning what is going with People with Disabilities (PWD) in developing countries, the need to promote the access to health services is essential and the need to develop and strengthen rehabilitation services is crucial.
Because if someone does not have good medical conditions or a PWD has no access to health technologies and assistive devices the possibility for survival are minimal and exercising other human rights is practically nil.
Q: You are leaving the Direction of the DAR unit, what were your good and bad experience with the WHO?
Dr. Federico Montero: I think that WHO is an organization that has all the potential and all the resources to make a difference in the lives of PWDs around the world, WHO has, through the years, had an effect on the quality of life of PWDs. And PWDs need to understand WHO better.
However, I don't think this is enough. In fact there is little awareness within the World Health Organization, and within all the programs of the WHO, that in any group of people that you are working with or working for, there is at least ten percent of those - if not more in may cases - that also have disabilities!
Disability is not a priority in this organization., the team working on this issue is very small, the financial resources are very limited; it is frustrating to accept this paradox: that WHO can do a lot but at the same time is not. That frustration is one of the reasons that made me decide to leave.
Q: What of Community based rehabilitation -CBR- which you helped promote?
Dr. Federico Montero: CBR is a strategy that WHO developed soon after the Alma Ata conference and it is a strategy based on Primary health care which has four basic pillars: promotion, prevention, management and rehabilitation.
It is obvious that rehabilitation has been over the years the most neglected component of PHC and considering the need to reach PWDs in poor or isolated communities, WHO developed and implemented the CBR strategy in an effective way.
CBR has now developed from being a medical oriented strategy to a multisectorial strategy to promote equalisation of opportunities, to reduce poverty and to promote social inclusion of PWDs. But CBR is not enough. There is a clear and urgent need to develop and strengthen rehabilitation services in the whole referral system of the countries. The proposition of the new Director General Margaret Chan to go back to the principles of Primary Health Care represents, to me, a positive and good opportunity to emphasise the need of the rehabilitation component of primary care.
Q: This year, the Disability movement had the satisfaction of seeing the Convention go through, your thoughts on this?
Dr. Federico Montero: The adoption of the convention by the UN General Assembly will have a big impact in assuring the inclusion of disability and rehabilitation issues within WHO. Already the DAR team has organized meetings and lunch time seminars to raise awareness in the organization about the need to be prepared once the Convention is ratified by at least 20 member States and becomes a legally binding document for the Member States.
Q: Shouldn't the WHA move disability out of the closet, and place the 600 to 700 million people up on the agenda? For example move to place the DAR unit further up on the structure. Isn't it bizarre to come under “car accidents” for a health body?
Dr. Federico Montero: During the next WHA, we will know about the progress report on the resolution on disability including prevention WHA58.23 approved in the May 2005 WHA, and this should be an opportunity for DAR team and for NGOs and DPOS in officials relations with WHO to raise awareness about the need of the 600+ million people around the world. If we recognized that disability affects at least ten percent of any group of people - but maybe a much higher percentage when we consider chronic conditions or communicable diseases or injuries and violence, it becomes obvious that WHO should put more resources, both human and financial, in this area. The emphasis on prevention is relevant and basic for the WHO, but what about the people that are left with a disability as a consequence of many of those diseases when all the resources are only channelled in a big way to prevention such as polio, leprosy, or others.
This year, several hundred millions to prevent a few cases of polio, and zero dollars for people who survive with polio today.
We know that for every person that dies in a road traffic injury there are 6-8 injured, and all these people need services. Same in war.
Patient safety is also a program in the WHO which should interact more with the disability movement, as people with disabilities attend health services more, are often discriminated against, and may suffer more injuries through bad care than others. But you know
Q: The Bias Free Framework is proposing to look at biases against disabled people in every area including health research, your thoughts as a participants to some of the seminars?
Dr. Federico Montero: I think the BIAS free framework represents a very good tool that we can use to detect biased or discrimination against people with disability and help put disability on every agenda.. Mary Anne Burke, who developed it with the University of Toronto, has been involving DPOs in the use of the tool. The Global Forum on Health Research has began to address disability issues through the BIAS Free Framework. Furthermore, I think that we cannot leave disability remain a neglected issue in health research, and the GFHR could do more in the future in this domain. If we don't include PWDs in any of these global health programs, the Millennium Development Goals will not be achieved because poverty is the main cause of disability and once a poor person becomes disabled, poverty perpetuate and increases disability.
More than 80% of PWDs live in developing countries and most of them are poor!
Q: You participated in the PHA, Cuenca, what would you think the next step and how can PHM better take people living with disability (PLD) into the program?
Dr. Federico Montero: Cuenca represented a great opportunity for me to know more about the PHM. I think PHM becomes now more relevant and more close to WHO when WHO is proposing to go back to the principles of PHC. I understand that the PHM should strengthen their activities on disability issues and it can be an excellent way to promote the access not only to health but also to rehabilitation services for PWD in developing countries and in poor communities of the developing world.
Q: What topics for the PHM's Global Health Watch on Disability. The PHM group at Hesperian has just publsihed a book on Women with disabilities, what more can we do?
Dr. Federico Montero: In conclusion, I would like to say that these rehabilitation services should not be organized in a vertical manner, but as the Convention says, this should be done in collaboration with PWDs and their families and they should be involved in the designing, implementing, monitoring and evaluation of the services provided. WHO should increase work in the regions on disability and rehabilitation. An advocacy movement like PHM could help PWDs move up the disability agenda on the international level and combat “vertical”, top down tendencies.

Garance Upham
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