Sitan disabilities highquality(updated) by UNICEF Belize

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The Situational Analysis of Children with Disabilities

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This Situation of Children with Disabilities Study was commissioned by the United Nations Children’s Fund (UNICEF). UNICEF gratefully recognises the work of Consultant Dr. Roy Young, as well as the contribution from all the participants who contributed their time and knowledge. Special thanks go to BCVI, Care Belize, NaRCIE, Ministry of Education and to all who willingly participated in the focus groups throughout all six districts. Without their invaluable cooperation, this research might not have been possible. For their guidance and support in this critical research, many thanks go out to the UNICEF team headed by the Country Representative, Christine Norton, and the technical advisors, Monitoring and Evaluation Officer, Paulette Wade , ECD/Education Officer, Denise Robateau and publication, Communication officer , Anna D. Hoare.

Published by Fer de Lance Productions for: United Nations Children’s Fund, Belize #1 Coney Drive, Gordon House 3rd Floor P.O. Box 2672 Belize City Belize, Central America Photography by: Anna D. Hoare, Francisco Cuellar, Dr. Roy Young Printed and bound in Belize © June 2013 | The United Nations Children’s Fund (UNICEF) Belize

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TABLE OF CONTENTS Acronyms........................................................................................................................ 5 Definition of Terms.......................................................................................................... 6 1.0 Introduction.............................................................................................................. 8 2.0 Background................................................................................................................. 10 3.0 Purpose of the Study................................................................................................ 12 4.0 Methodology............................................................................................................ 14 5.0 Prevalence of Disability in Belize.............................................................................. 15 6.0 Health....................................................................................................................... 19 7.0 Education.................................................................................................................. 21 7.1 Zero to younger than three........................................................................ 21 7.2 Three to Under Five................................................................................... 21 7.3 Five to Sixteen-eighteen............................................................................ 22 7.3.1 Enabling Environment................................................................................ 22 7.3.2 Accessing Services (Education)................................................................. 23 7.3.3 NaRCIE...................................................................................................... 25 7.3.4 Transition from Primary School to High School.......................................... 29 7.3.5 Examinations............................................................................................. 29 7.3.6 Collaborations............................................................................................ 30 7.3.7 Challenges................................................................................................. 30 7.3.8 Stella Maris................................................................................................ 31 7.4 Fourteen to Under Sixteen........................................................................ 32 7.5 Sixteen to Under eighteen......................................................................... 32 7.6 Eighteen and older..................................................................................... 33 Belize Assembly of Persons with Diverse Abilities (BAPDA)..................... 33 8.0 NGOs that Support Children with Special Needs..................................................... 34 8.1 CARE Belize............................................................................................... 34 8.2 Belize Council for the Visual Impaired (BCVI)............................................. 36 8.3 Red Cross.................................................................................................. 37 8.4 World Pediatric Project (WPP).................................................................... 37 8.5 Office of the Special Envoy for Women and Children................................ 38 8.6 Belize Special Olympic.............................................................................. 38 8.7 Rotary Club of Belize................................................................................. 39 8.8 Parent Support Organizations.................................................................... 39 8.9 Other Organizations.................................................................................. 39 9.0 Child Protection....................................................................................................... 41 10.0 Legislation.............................................................................................................. 44 11.0 Stigma and Discrimination...................................................................................... 49 12.0 Findings.................................................................................................................. 50 Other findings....................................................................................................... 52 Education.............................................................................................................. 53 Health................................................................................................................... 54 Child Protection.................................................................................................. 54 13.0 Recommendations................................................................................................. 55 14.0 References............................................................................................................. 58

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Appendix 1: Persons Consulted/Interviewed....................................................... Appendix 2: Total Persons with Disability by Type of Disability and sex for Major division................................................................ Appendix 3: Children with Disability by Type of Disability and Sex....................... Appendix 4: Children with Disability by Type of Disability and District.................. Appendix 5: Families and Children Act 2000, Part II Section 3 to 9...................... Appendix 6: Amendments to Families and Children Act 2000 according to Owen 2003.................................................................. Appendix 7: Data Collection Instruments............................................................. Questionnaire for Teachers/Principals of Schools.................................................. Questionnaire for NGO’s, CBO’s and FBO’s.......................................................... Questionnaire for Students................................................................................... Appendix 8: Inventory of Publications Relevant for the SitAn..............................

60 62 63 64 65 66 67 67 67 67 68

TABLES Table 2.1: The Nature of Disability: Interrelationship of Factors............................. 11 Table 5.1: Persons with disability by age group and sex …...…………................. 16 Table 5.2: Number and percentage of children with disabilities by district …..…. 18 Table 5.3: Percentage disabilities in children by sex in 2000................................. 18 Table 7.1: Coverage of Children with ELNs by District ......................................... 27 Table 7.2: Home visits made by NaRCIE and CARE.............................................. 28 Table 7.3: The number of applicants for special assistance to sit the PSE and CXC.....….................................................................................. 30 Table 8.1: CARE’s clients by rural and urban areas............................................... 35 Table 8.2: Home visits made by NaRCIE and CARE............................................. 36 Table 8.3: Organizations that support children with disabilities............................ 40 Table 10.1: International Conventions and Declarations ....................................... 45

FIGURES Figure 5.1: Figure 5.2: Figure 5.3: Figure 7.1: Figure 7.2: Figure 8.1:

Percent of Total Population with disabilities........................................ Distribution of children with disabilities by district.............................. Distribution of children with disabilities by sex................................... Coverage of children with ELNs by district......................................... Disabilities and special needs of students currently enrolled at Stella Maris 2009.............................................................. Blind and visually impaired students in school by level of school.......

17 17 17 27 32 36

BOXES Box 1: The Case of Mia’s Education..................................................................... 24 Box 2: Some Reasons for Special Educational Programs..................................... 29

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Box 3: Box 4: Box 5: Box 6: Box 7:

Baby Joshua’s story about his chance at life............................................. Two success stories of Belize Special Olympics....................................... Article 23 of the Convention on the Rights of the Child............................ Education laws related to children with special needs.............................. Aims of the ECD Policy relevant to children with special needs...............

38 39 46 46 48

ACRONYMS AAA Alliance Against AIDS AIDS Acquired Immune Deficiency Syndrome BAPDA Belize Assembly of Persons with Diverse Abilities BCVI Belize Council for the Visual Impaired BFLA Belize Family Life Association CARE Community Agency for Rehabilitation and Education of Persons with Disabilities CBR Community Based Rehabilitation CNA Community Nurse Aide COMPAR Community Parenting CP Cerebral Palsy CRC Convention on the Rights of the Child CSN Children with Special Needs ECLAC Economic Commission for Latin America and the Caribbean EFA Education for All ELN Educational Learning Needs GOB Government of Belize HECOPAB Health Education and Community Participation Bureau HFLE Health and Family Life Education ITVET Institute for Technical/Vocational Education MICS Multiple Index Child Survey MoE Ministry of Education MoH Ministry of Health NaRCIE National Resource Centre for Inclusive Education NCFC National Committee for Family and Children NHI National Health Insurance NOPCAN National Committee for the Prevention of Child Abuse and Neglect NPA National Plan of Action PACSN Parent Association for Children with Special Needs PEC Primary Eye Clinic RFO Rehabilitation Field Officer SIB Statistical Institute of Belize SitAn Situational Analysis UB University of Belize UNESCO United Nation Education, Scientific and Cultural Organization UNICEF United Nations Children’s Fund WFFC World Fit for Children YWCA Young Women Christian Association

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DEFINITION OF TERMS Child: A child is a person below the age 18 years. Disability: Results from the interaction between persons with impairments (hemophilia, HIV/AIDS, cancer, kidney failure, diabetes, asthma and heart disease) and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others. Educational Assessment: An educational assessment is the formal process of collecting information about a student to be used in forming judgments and making decisions concerning that student. The major purpose of an educational assessment is to improve instruction to help the student learn. Exceptional Learning Needs (ELN): Students with Exceptional Learning Needs are those students with or without disabilities who present more difficulties than other students of his/ her age; they present special talents and to be given appropriate attention they need to be provided with support resources and modification and/or accommodations to one or various aspects of the school curriculum and to the educational facilities. Inclusive Education: Inclusive education is based on the affirmation of the same rights to equal education for every person to learn within his or her own community (NaRCIE). Most Enabling Environment: The Most Enabling Environment in education children according to NaRCIE is to have children as close to the regular classroom setting as is feasible. â&#x20AC;&#x153;This principle recognizes that where it is not in the best interest of the child to be included in the class, he or she may need a different setting for the teaching-learning process. Both home-schooling and the maintenance of special schools and classes and resource rooms must, therefore, be considered in the plan of actionâ&#x20AC;? (NaRCIE Five Year Plan 2010-2015). Special Settings: Special settings refer to places other than the normal places children are educated including home, special education class, and special education center. Community Based Rehabilitation (CBR): Community Based Rehabilitation is involving all community stakeholders in the rehabilitation of persons with disabilities especially the family of the person and include teachers, school principals, community nurse aids (CNAs), schools, the churches, NGOs, CBOs, FBOs and government departments. The interaction with different people in the community is critical to disabled personsâ&#x20AC;&#x2122; development and wellbeing so they have to be trained and sensitized to provide the best socialization and accommodation for these persons.

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INTRODUCTION

The concept of disability in Belize has evolved over the past years to accommodate the complex, multidimensional and dynamic nature of the issue. An understanding of the evolution of the disability concept in Belize gives an insight into the key issues of disabilities and what impact it has on families, the community and primarily children living with disabilities. Previous studies by Laura Longsworth, UNICEF and others have provided a framework for analyzing the conceptual base of service delivery programs by key stakeholders. Most studies conducted point to the fact that persons with disabilities in Belize are constantly being discriminated against and excluded from participating in education, recreation, employment opportunities and accessibility. To exacerbate this situation poverty often hinders them from accessing education, rehabilitation, skills training and employment that further aggravates the vicious cycle of poverty and disability. It is obvious however that the perception of disability itself has undergone tremendous change over the years in Belize which is reflected in models such as medical, social, and rights-based approach which has played a significant role in promoting equality of opportunities and dignity. This year the Convention on the Rights of Persons with Disabilities was signed, and this was a major step taken by the government. Belize is committed to fulfilling the Millennium Development Goals which is a step toward ensuring that all persons participate in the governmentâ&#x20AC;&#x2122;s key initiatives outlined in the MDGs in an effort to reduce poverty. Through the efforts of organizations like BCVI and CARE-Belize, the disability movement continues to gain strength. The establishment of organizations of/for persons with disabilities and parent support groups countrywide symbolizes this momentum. This movement encourages people with disabilities to take control of activities and policies that affect their lives. It aims at achieving full participation and equalization of opportunities for, by and with persons with disabilities.

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In order to change a society that excludes and discriminates against children with disabilities, it is necessary to create inclusive societies in which everyone can participate and contribute. The global trend today is inclusion and it is a process that enables the people included to have the same opportunities and decisionmaking powers on how to organize society as others. Our country needs to strengthen some areas to reach the goal and need to put other programs in place as well. The government needs to consider children with disabilities in

planning for education programs, construction of new school buildings, and building the capacity of teachers to confront the challenges of children with disabilities. To do that however, entail that persons with disabilities themselves take a leading role in the process of inclusion, as experts on the way in which they want society to treat them. This means that people with disabilities must be presented with the same opportunities as other members of society in decisions on all policies, action and plans that concern them.

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BACKGROUND

This Situational Analysis was guided by the principle of inclusion reflected by the statement “Nilhil de nobis, sin nobis” translated “Nothing for Us, Without Us” (the quintessential statement of the global movement). It takes into account trends, policies, structures, services and social budgets relating to the rights and welfare of girls and boys 0-18 years living with disabilities. Childhood disabilities in Belize and throughout the world has been defined and measured differently depending on the purpose, the need and the organization collecting data. Whilst globally different terms have been used, here in Belize a uniform definition or classification has yet to be identified by, educational, social and even policymakers. This creates difficulties in studying the scope of disability of children in Belize and is why such varied prevalence figures, ranging from 2-26%, are reported depending on which study is examined. This poses a major challenge in planning, implementation, monitoring, and evaluation of programs or even policies that need to be put in place. In Belize there are various disability models that are practiced including the charity model. The leading organizations however have embraced the model put forward by World Health Organization and have merged other concepts to provide the necessary interventions. Over the past years we have noted a strong inclination toward the Social Model of disability which sees the person with a disability not the disabled person. This model seeks to assist people with disabilities by changing the environment in which they live, work, and play; they see the problems that society have placed in their way and appreciate the need for campaign to change. There are various figures reported for prevalence of disabilities in Belize. Data from the 2010 census were not available at the time this report was prepared. The 2012 MICS report shows that more than a third (36.4%)

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of children 2 to 9 years was at risk for one or more disabilities. This is ten percent more than what it was in 2006. However, this data is not comprehensive because it leaves out other children between zero and eighteen. Variances of these figures may be attributed to parents’ non-disclosure of information on children with disability. Underestimation of disabilities is a trend seen in developing countries (World Bank: No. 05/201/LAC). Additionally, we are reminded that “the use of short questions in censuses tends to underestimate special population groups such as children, the elderly, and persons with cognitive and psychological impairments” (Robson, OECD Secretariat). Dudzik, et. al. also reports that the author of WHO’s 10% formula, which is used to estimate disabilities in countries, revised the percentage downwards to a global rate of 5.5% for developed countries and 4.8% for less developed ones. In the absence of a Disability Act, there are several documents that incorporate the rights of persons with disabilities in Belize. A non-discrimination clause in the Belize Constitution (S.6-1) states that all persons (children) are equal before the law and are entitled without any discrimination to the equal protection of the law.

The Families and Children Act 173 provides for support and protection of children. There is specific reference to children with disabilities (Part II-8) in which it states that authorities:

“shall take appropriate steps to see that those children are (1): (a) assessed as early as possible as to the extent and nature of their disabilities and (b) offered appropriate treatment. (2) The State shall take appropriate steps to ensure that children with disabilities are afforded equal opportunities to education. A court considering any question with respect to a child under this Act may ask the Department to arrange for social services practitioner or such other person as the court considers appropriate to report to the court on such matters relating to the welfare of that child as are required to be dealt with in the report.”

With a very inclusive policy on Education as well, children with disabilities continue to be stigmatized and denied places in school. This is even encouraged by school managers. Whilst advances have been made towards inclusive education, especially in the area of blindness there is more that can be done.

Table 2.1: The Nature of Disability: Interrelationship of Factors

ADJ US TT I

ENVIRONMENTAL FACTORS

SOCIO-CULTURAL FACTORS Disability as Deviance Socialization Social Interaction Cultural Differences Role of the Family Sexuality and Disability

N TIO TA AP D

G N

BILITY: COPIN A S Ga DI nd TO Architectural Factors Transportation Support and Guidance

PSYCHOLOGICAL FACTORS

Mobility Adaptive Devices Information

Self - Concept Love Self - Disclosure Locus of Control

Stimulation Challenge Risk Teaching Elements Modification

AGE OF ONSET OF DISABILITY

According to the 2011 World Report on disability there is an implicit assumption that each “type of disability” has specific health, educational, rehabilitation, social, and support needs. This study presents findings and recommendations based on three factors; socio-cultural, environmental and psychological with emphasis on adjustment mechanisms necessary.

MANNER OF ONSET OF DISABILITY IMPACT OF DISABILITY ON INDIVIDUAL’S LIFESTYLE

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PURPOSE OF THE STUDY

The purpose of the Situational Analysis is to:

 Develop a deeper understanding of the situation of girls and boys ages 0-18 years through demographic and socio-economic trend analysis and the testimony and judgment of children, adolescents, as well as professional practitioners;  Develop recommendations for action to strategically help position UNICEF as a development partner in a middle income country and a rapidly changing environment in preparation of the next country program and as a contribution to the next United Nations Common Country Assessment;  Contribute to the generation of evidence-based knowledge and identification of critical information gaps that stimulate dialogue on, and serve as a basis for rights based and child centered/sensitive policy making;  Contribute to UNICEF’s commitment to develop national capacity in general and research capacity on children in particular those with disabilities, living in south-side Belize City and Toledo;  To identify and document model practices in the area of inclusive sports, education, and to highlight the mechanisms and strategies that have proved effective, the areas of concern and the constraints in successfully mainstreaming children with disabilities;  To provide recommendations for the development of specific strategies for future interventions.

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The specific questions that the Situation Analysis answered are: 1. Which rights of children (0-18) living with disabilities are unfulfilled and why? 2. What rights of children (0-18) living with disabilities are upheld and in what ways? 3. What is the status of wellbeing and deprivation of children with disabilities in Belize? 4. Who are most excluded and who are those that are excluded 5. To what extent does violation of rights show disparities by sex, age, physical ability, ethnic background and geographical residence?

7. What role do systems and institutions play in the fulfillment of exclusion of rights? 8. What would it take to make systems work for children (0-18) living disabilities? 9. How enabling is the legal and policy environment? 10. What solutions do children (018) living with disabilities and practitioners perceive to address the violation of rights? 11. What capacities are required to fulfill these expectations and rights? 12. What are the existing knowledge gaps on the situation of children (0-18) living with disabilities?

6. What are the causes for this exclusion and violation of rights?

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A meeting of the Belize Assembly of Persons with Diverse Abilities (BAPDA) was attended. The purpose of the meeting was to build awareness about the Convention on the Rights of Persons with Disabilities (CRPWD) which was recently signed on June 10, 2011 and to elect new officers. A meeting of the parents of children in a special education class in Santa Elena Primary School was attended to better understand the functions and activities of such a group.

At least three primary schools in each district were visited to observe the environment in which children with disabilities function. The visits also provided opportunities to interview children, their teachers, principals, and classmates. Visits were also made to four high schools. Home visits to two to five CSNs’ homes in each district helped to get a comprehensive picture of the environment of these children. NaRCIE’s IROs and CARE Belize’s RFOs in each district guided the consultant to the CSN and were interviewed to further understand the situation of children with disabilities in their locality. Two in-depth and two brief interviews were conducted with the Manager of NaRCIE to get detailed information about the services the department offers.

METHODOLOGY A conceptual and analytical secondary research was conducted of all relevant and available research, reports, and documents including the last SitAn of Children with Disabilities done in 2006 and the SitAn of Children and Women completed in 2011. A comparative analysis of UN conventions, legislations, policy, and national plans was conducted to succinctly describe the legal framework in which children with disabilities exists.

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Representatives of many NGOs and CBOs that support or directly work with children with disabilities were interviewed (see List of Persons Interview and or Consulted in Appendix 1). They were accommodating and readily shared the information they had. These organizations include World Pediatric Project, PACSN, BAPDA, CARE Belize, BCVI, Belize Red Cross, and Handin-Hand Ministry. The situation of children with d in Belize was also illuminated by the data and records of these organizations, even though in many cases were incomplete and or incomprehensive. An online search for documents and literature related to children with disabilities yielded several relevant and useful references including ECLAC reports, a regional report of the Americas from the IDRM, and an analysis of the laws of Belize as they relate to the CRC by Owen (2004).

PREVALENCE OF DISABILITY IN BELIZE According to the Economic Commission for Latin America and the Caribbean (ECLAC) (2009), in 2000 Belize had 13,774 disabled persons (6,988 males and 6,786 females) which were 5.9% of the population. See Table 5.1. The report also showed a prevalence of 2.5% in the age group 0-4 years which was the highest of nine Latin and Caribbean countries studied. In the age group 5-19 the percentage was the same. The International Disability Rights Monitor (IDRM) (2004) estimated that in 2000 the percentage of children between 3 and 18 years diagnosed with some form of disability was close to 15%. There is no comprehensive database of all children with disabilities in Belize. CARE Belize, BCVI and NaRCIE and others have databases of their clients but even if these were to be combined, the new list would not have many children because not all children are captured in these databases. Some parents donâ&#x20AC;&#x2122;t bring their children out of their homes because they are ashamed of them and or they donâ&#x20AC;&#x2122;t think they can be helped so why make the effort. A child in Roaring Creek who had severe cerebral palsy was born at home and does not leave the home. The IRO and the RFO both knew of the case. He was on Cayo IROs database & received home visits & physical therapy support annually. There was however, an eight-year girl with intellectual impairment in San Jose, Orange Walk district who has never been to school and was not a part of any database. According to ECLAC 2011 Belize, Guyana and the Netherlands Antilles had the highest proportion of persons with disabilities of fifteen Latin American and Caribbean countries studied using their 2000 census data. ECLAC 2011 estimated that with no change in the disability risks as measured in Census 2000, the percentages of disabled persons in Belize will grow to 9.5% in 2025 and 14.6% in 2050. Figure 5.1 shows the trend in

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the number of persons with disability in Belize using ECLAC estimates for 2025 and 2050. IDRM (2004) has figures that vary from those of ECLAC even though both reports claim to use data from the census. IRDM has that the 1991 percentage of persons with disability in Belize was 6.5% and 5.7% in 2000. The 2000 census shows that of the 2,907 children with disabilities, most of them were in Cayo district (29%) followed by Belize (17%) and Toledo (17%) then Corozal and Orange Walk, each with 14%. The district with the least percentage was Stann Creek with nine percent. See Table 5.2 and Figure 5.2. Most of the children with disabilities were males (53%). Males were 50.4% of the children population but were 53.0% of the children with disabilities. See Figure 5.3. They were more likely to have speaking (33.3%), learning (50.0%), behavioral (50.0%), other (50%) disabilities than females. Females were, however, more likely than males to have sight disabilities (16.7%) and there were difference for hearing, moving/mobility, body movement, gripping/ holding, and personal care. See Table 5.3.

primary caretaker. According to the MICS 2006 more than a quarter (26.3 %) of children aged 2 to 9 years was reported to have at least one disability, with the highest proportion (50.9 %) living in Toledo District and the lowest in Belize District (17.1 %). The data also showed that the children with Mayan parents were more likely to have a disability than children of other parentage, 43% and 22-29%, respectively. The report did not disaggregate the information by gender. The 2012 MICS report shows that more than a third (36.4%) of children 2 to 9 years was at risk for one or more disabilities. This is ten percent more than what it was in 2006. The highest at risk percentage was recorded in the Cayo District (59.3%) which was a shift from the Toledo District in 2006. The lowest at risk percentage was in Belize City South Side (23.0%) but was an increase from 2006 when it was 17.1%. The report did not disaggregate the information by gender or parentage but shows that children living in rural areas were at higher risk for disabilities than urban children (urban 28.3%, rural 41.5%)

Given that the 2010 population census data on children with disabilities was not available, prevalence was estimated using the MICS Survey. A limitation in using the MICS to determine prevalence is that it considers only children 2 to 9 years. The MICS survey was designed to identify children at risk for disability in ten areas: walking (gross motor skills), hearing, seeing, understanding, movement (fine motor skills), learning, speaking and mental slowness. The information was reported by the mother or the

Table 5.1: Persons with disability by age group and sex Year

Male

0-4 Female

1991 2000 434 411 2010 N A NA N Source: ECLAC 2009.

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Total 845 A

Male

5-19 Female

1175 NA N

1008 A

Total

Male

2183 1614 NA N A

Total Female

Total

1419 3033 NA N A

Figure 5.1: Percent of total population with disabilities based on EClAC estimates

16 14

Percent

12 10 8 6 4 2 0

1991

2000

Figure 5.2: Distribution of children with disabilities by district

2025

2050

Figure 5.3: Distribution of children with disabilities by sex

Stann Creek

Cayo 29%

Corozal 14% Orange Walk 14% Toledo 17%

Female 47%

Male 53%

Belize 17%

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Table 5.2: Number and percentage of children with disability by district 1991

District

Total children

Total children with disabilities

Total

2000

Percent

of all

Children

children

with

Total

Total children

with disabilities

disabilities disabilities NA

children

2010

Percent

of all

Children

children

with

Total children

2,907

2.51

100.00

Corozal

15,791

399

2.53

13.73

Orange Walk

19,272

410

2.13

14.10

Belize

28,542

503

1.76

17.30

Cayo

26,766

848

3.17

29.17

Stann Creek

12,292

246

2.00

8.46

Toledo

13,344

501

3.75

17.23

Source: Statistical Institute. of Belize 2000

Table 5.3: Percentage disabilities in children by sex in 2000 Disability

Male

Female

Speaking

0.8

0.6

0.2

Learning

0.6

0.4

0.2

Behavioral

0.3

0.2

0.1

Other

0.3

0.2

0.1

Hearing

0.4

0.0

Moving/Mobility

0.4

0.0

Body Movement

0.3

0.0

Gripping/Holding

0.2

0.0

Personal Care

0.7

0.0

Sight

0.6

0.7

- 0.1

Source: SIB â&#x20AC;&#x201C; 2000 Population Census data Page 18

children with disabilities

disabilities disabilities

116,007

Total

Percent

of all

Children

children

with

disabilities disabilities NA

HEALTH

The Ministry of Health has the Maternal and Child Health program as top priority, since maternal and infant mortality rates are indicators of the general health of the population. Several strategies are employed by the MOH for the prevention, treatment, and rehabilitation of disabilities in children, which include the following: 1. Administration of Tetanus Toxide to pregnant women to prevent Neonatal Tetanus should the woman be exposed to unsterile practice during the delivery process. 2. Treatment regime according to the established protocol to prevent mother to child transmission of HIV in HIV positive pregnant women. 3. Administration of Iron and Folic Acid to pregnant women to prevent anemia in pregnancy and neural tube defects in the child. 4. Vaccination of females and males against measles, mumps, and rubella (MMR) to prevent congenital rubella syndrome in the newborn. 5. Administration of oral polio vaccine to children to prevent poliomyelitis. 6. Administration of Vitamin A (Vitamin Angels Program) to children to prevent eye diseases and blindness. 7. Provision of nutrition supplements to women and children at risk of malnutrition (INCAPARINA). During the period 2000-2004 the underweight prevalence at birth was 4.2 percent compared to 6.9 percent 2005-20071. One of the health targets of the NPA is â&#x20AC;&#x153;to reduce the incidence of low birth weight (less than 2.5 kg.) to 3.7 percent of all birthsâ&#x20AC;?.

PAHO 2009.

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8. Provision of family planning and child spacing education and contraceptive products to women to prevent too many pregnancies (Less than five children recommended) and the accompanying complications. 9. The Japan Social Development Fund (JSDF) provided a grant that is being used to finance a project aimed at Improving Children’s Health and Nutrition in Poor Mayan Communities in Toledo All of these services, except for the last one, are provided countrywide through the MOH network of seven hospitals, 34 health centers and through outreach services provide on mobile clinics. Home visits are also done to clients who do not return for follow-up care including immunizations and prenatal care. The 240 Community Health Workers who provide voluntary service are the link between the community and the health system. They identify at risk clients and provide health education and health promotion activities in their individual villages. There is strong collaboration for technical, financial, and material resources with UNICEF, PAHO, JSDF, Hand in Hand Ministries, the International Children’s Hospital, BCVI, BFLA, the World Bank, the Caribbean Development Bank and the Global Fund. Bilateral agreements with Cuba, Nigeria, Guatemala and Mexico also aid the management and delivery of programs to families and children. Challenges related to the provision of services for the prevention, treatment, and rehabilitation of children with diverse ability are mainly financial and insufficient health human resources. Occasionally, supplies are out of stock which is often relieved by borrowing from the MoH Mexican or Guatemalan counterparts. According to Dr. Marjorie Parks, Deputy Director of Health Services (Nursing), the Ministry of Health does not have any specific programs to address children with physical or intellectual disabilities. The National Plan of Action 2004 to 2015 (NPA) target is to increase the accessibility and affordability of mental health services to all children and their families but outlines strategies which are unlike the other health targets that are specific and measureable. This goal should be

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realized by including mental health services for children and adolescents in the National Health Insurance package; develop, implement and enforce protocol for the clinical management of sexual violence, domestic violence and child abuse cases; review and revise mental health policies and legislation to include provisions for children; and develop and implement comprehensive public awareness programs on mental health issues affecting children. Approximately 50 children annually get tertiary medical care including surgeries and corrective procedures through international corporations. These procedures are mostly done in the United States without cost to the children’s families. All patients are screened in clinics in Belize by the respective organizations before they are finally selected for corrective surgeries and procedures abroad.

EDUCATION

7.1

Zero to younger than three

No systematic education takes place during this period of the life cycle except for early stimulation that is provided by Rovers of COMPAR in Toledo District and Southside Belize City. Parents also provide stimulation to their children with disabilities sometimes on their own volition and on advice of a CNA and others.

7.2 Three to Under Five At the preschool stage of development (age 3 to 5) there is no legislation regarding access of children with disabilities to education but the draft ECD policy has accommodation for children with disabilities as shown in Box 5. According to Margaret Williams, Preschool Education Officer, even though the policy is a draft document the Early Childhood Unit does as much as it can to serve children with disabilities but major San Roman Preschool, Stann Creek limitations are access to building, the absence of bathroom and other facilities to accommodate children with disabilities, the lack of trained teachers, and getting the children from home to the preschool. She agreed that more and more preschools are being built with ramp access as the case at San Roman, Stann Creek District, Chan Pine Ridge, Orange Walk District, and Chan Chen, Corozal District.

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7.3 Five to Sixteen-eighteen 7.3.1 Enabling Environment Government departments and NGOs are working together to provide an enabling environment for children with disabilities. However, because of limited human and financial resources it is difficult for government, schools, and other stakeholders including families to provisions the individualized enabling environment for all children to access and stay in school.

treated as peers by classmates. Most of the children with physical disabilities were assisted by their classmates. A student with cerebral palsy in standard five at Roaring Creek Nazarene School was assisted by her classmates. This was a success story for CARE Belize and NaRCIE because this student started school in Infant 1 with total dependence on the care of the mother and gradually weaned from her mother’s support to getting support from teachers and students. This student had two good school friends who gave her all the support she needed in school. The mother had to physically carry the student up a twenty-flight stair to her classroom. She also did this at lunch time because she had to change her at that time because the school did not have a facility for this. The child was happy to be on the second floor because she could overlook her surroundings.

Schools throughout the country are working towards the establishment of special education class or center. A center was opened in October this year at Santa Elena RC Primary School, Cayo. The building was constructed with funding Conducive learning environment from Belize Natural Energy (BNE). One major problem with the new building is that the bathroom is not accessible to a mobility disabled child. A room at Nazarene Primary School in Roaring Creek, Cayo is being repaired and ready to accommodate special education students in a ‘pull out program’ in which students are pulled out of their regular class at different time for various subjects. This room will be ready by the end of December 2011. Most of the ten special education centers/classes countrywide are conducive to learning with many learning corners and teaching aids. Learning corners are areas in a classroom where students can engage in individualize learning. Special education centers are in all districts except Belize district. One special education class was observed to be non-conducive to learning without displays of students’ work and learning corners and the special education center in Dangriga Town needed expansion and repairs to its building. Most children with ELNs and disabled children in regular classes were accepted and

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Another similar case of inclusion seen was a student with cerebral palsy in Standard 3 at Hopkins School, Stann Creek district in which a ten-year old girl was fully included in her class. She even participated in physical education by acting as referee and blowing a whistle. However, a major limitation of this child was physical access to her classroom (no ramp and bathroom facilities). At the time of this study a wooden ramp was in the making for the school.

Student is taken up these stairs twice daily by her mother.

Observations of classrooms in Armenia and Santa Elena primary schools revealed a high level of interaction among students working in groups of four. The teachers and principals of these schools said the cooperative

learning approach helps to promote inclusive education for CSN. The IDRM Regional Report of the Americas 2004 identified Belize as a country that was least inclusive which means that the country lacked the most basic elements necessary for the social inclusion of people with disabilities.

Dedicated IROs from NaRCIE and RFOs from CARE Belize provide early stimulation for children. From the observations in the field during data collection for this situational analysis, it appeared that IROs work and bond well with the families and schools of CSN. An IRO cried with a mother of a seven-year old CP son who passed away two months before our visit. This was a success story for the IRO and the RFO because they were able to change the attitude of the parents over a period of three years.

As discussed elsewhere in In instances where it is not the this document best interest of the child to be ina major limitacluded in a regular class, the child tion in providis placed in a special education ing an enabling class or center within a regular environment school and participates in activifor CSN were ties for which they have the capacqualified teachity. For example, some children ers. Most of the with ELNs will go to the special teachers intereducation class for Math and Engviewed in this lish and attend a regular class for San Roman Preschool, Stann Creek study did not Science and Social Studies. An have any forextreme case is Peter in Libertad, mal training in Orange Walk, who suffered from special education. One had a master’s degree in autism and a mental disorder. He is eleven years, special education and the other extreme was a cannot talk, is not potty trained and doesn’t follow person with an associate degree in business adinstructions. He stays at home with his grandparministration who had no teaching experience or ents. teacher training except for an eight-week stint at Stella Maris and a two weeks training with NaR7.3.2 Accessing Services (Education) CIE. Students like Mai, whose situation is disThe level of participation in primary and secondcussed in Box 1, needed qualified, experienced, and motivated teachers to make a difference in ary education is summarized by the following: their lives. Similarly, a boy in San Jose, Orange Walk who has muscular dystrophy was encouraged not to attend school by his teacher and prinOf all elementary students with disabilicipal because he would fall sometimes when he ties: 50% receive inclusive education in walks. He left school when he was eight years which all students of the same grade are old and was in standard two. He is now sixteen in the same classroom; 15% are taught years. in special classes; 3% attend special day schools; 17% are taught at home; and 15% The enabling environment for CSN is supported have no education available to them. With by parents’ organizations as in the case at Sanregard to high school students with dista Elena primary school. Parent support groups abilities: 65% receive inclusive education; raised funds to support children attending school. 5% of students are taught at home; and The group in Orange Walk also provided loans up 30% have no education available to them. to $200 to its members to take care of emergency (IDRM 2004) needs of their children with disabilities.

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Box 1: The Case of Mia’s Education

Mia’s family lives in a rural village in the West. Life has been difficult with one parent working off and on and the other responsible for her aging grandmother and little sister who is confined to bed. Mia’s sister has severe cerebral palsy and Mia herself has been diagnosed with Down Syndrome. It has been difficult for Mia at school as her teachers do not understand her delay and her behavior. She is limited in speech and is performing below level in all subjects. Mia is very friendly and chatty. She can dress herself and use the bathroom with some supervision. She can go to the shop to buy small items, especially the treats that she likes. Mia’s Infant 1 teacher has returned from internship and is quite impressed at the strides Mia has made with her writing, drawing circles and tracing numbers 1-3. She has just started to write the first initial of her name. However, her current teacher is quite frustrated with her behavior and her incessant sharpening of pencils. A parent conference is conducted and interventions are put in place. The commitment of the school personnel only lasted for a few months. Mia is eventually asked to leave the school voluntarily.

Many children with disabilities are accessing education and many are not because their parents feel ashamed of them while some don’t have the economic means. There are dedicated and committed parents like the one the author saw carrying her seven year old daughter to school up a hill through an uneven and rocky narrow path to Armenia Government Primary school. Another parent in Roaring Creek carried her ten-year old daughter to school and up a twenty-five flight of stairs. This parent has been carrying her daughter to school from she was five years old. Some children like Aminidi at St. Peter’s Anglican Primary School traveled all the way from San Victor to Orange Walk Town to attend school. What do parents who live further away from school do for their child? What will happen when the child in Armenia gets heavier? How many students are not attending school because of the challenge to reach school? This question is asked of IRO, RFO, education officers and others but no one wanted to give an approximate number or percentage.

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For example, a child in Guinea Grass village successfully completed primary school and was admitted to high school but the parents could not afford to pay for the daily transportation of the child to high school in Orange Walk Town so the child did not attend high school. Approximately the same number of children is serviced in rural and urban areas by NaRCIE but more children in rural areas than in urban areas are serviced by CARE. BCVI does not have its information disaggregated by rural/urban but its Executive Director feels that it services all children in rural and urban areas who seek their assistance.

Some parents go all out for their child to get the best available health service. For example, a step-father from 7-miles, San Antonio, Cayo district takes time off from his job to accompany his wife to take their child with a disability to see a doctor in Belize City. On the other hand, there are parents, like one in San Roman who made little effort for one of her two sons with cerebral palsy because he was not able to maneuver his go cart to school and his mother said he didn’t like school. Another parent who had a child with autism did not make the effort to attend training sessions organized by the NaRCIE’s IRO and CARE’s RFO. As part of the CBR approach teachers, principals, community members, and others would attend training sessions organized specifically for this parent who would be either late or absent. The parent eventually withdrew the child from school. When parents, teachers, social workers, CNA, and national organizations have cases that they cannot manage or cannot be addressed in the country, they seek the services of international organizations like World Pediatrics. For example, when RFOs have a child with cliff lip they would seek assistance from World Pediatrics and when IROs have a child in need of occupational therapy they seek support from professors and interns from the University of Indiana. Other support is also garnered from the Wheelchair Foundation and Pro World.

All twenty-four primary school principals interviewed said they have not turned away any child with disabilities who have applied to their school. This could be because parents know schools that don’t have ramps, bathroom, furniture and equipment to accommodate children with disabilities so they don’t bother to apply to them. Belize has no accessibility to school legislation for children with disabilities.

7.3.3 NaRCIE Children at primary and secondary school ages with disabilities are encouraged and facilitated to attend regular schools by the Ministry of Education through the National Resource Center for Inclusive Education (NaRCIE). NaRCIE’s mandate is to “ensure that All our children [with disabilities] are provided with equitable opportunities to achieve his/her individual best in all aspects of life”. This Center started in January 1991 as the Special Education Unit (SEU) but was refocused and renamed NaRCIE in 2007. Over the years the department has evolved into a well recognized department in the Ministry of Education that contributes to the attainment of the Rights of the Child, rights under other international conventions and declarations, and national laws, policies and plans (e.g., the National Plan of Action). All this is done through inclusive education which is operationalized using UNESCO’s definition of inclusive education and inclusive schools as follows.

propriate learning opportunities to students to participate actively in the classroom learning activities and to expect all students to behave with respect for the learning of others. A school’s obligation in promoting inclusive education is to place students in age-appropriate regular classrooms, to provide an environment that is inviting, pleasant, clean, and accessible to ALL students, and to provide a positive Inclusive Climate through policies, programs and practices that are equitable for students. NaRCIE reaches children with Exceptional Learning Needs (ELN) through referrals from schools and on an informal level a few cases are referred to the Itinerant Resource Officer (IRO) by parents and individuals who know about their work. A few others are discovered by the IROs when they encounter a child they suspect has a special need. In the latter the IRO might be on a bus, and a conversation with the child or the parent would reveal that the child is not attending school. Recommendations and follow-ups would typically be made for the child to attend school.

IROs work with children in the schools. There is a total of 11 IROs, four in Belize district, two each in Orange Walk and Cayo districts, and one each in Corozal, Stann Creek and Toledo districts. These officers are trained in various aspects of special education with an average of fifteen years working with children with disabilities. The NaRCIE staff is well qualified with eleven having master’s degrees, two with bachelors and two with associates degrees. There is one itinerant teacher who is a trained teacher at This approach requires teachers to provide apthe associate degree level with over fifteen years of teaching experience. The staff all participate in at least one in-service training each quarter. Inclusive Education is a system in which all pupils with special educational needs are enrolled The IROs cannot service all the chilin ordinary classes in their district schools, and dren in the more than 40 to 50 schools are provided with support services and an edassigned to each of them because the ucation based on their strengths and needs. number is large, limited departmenInclusive Schools are based on the basic printal transportation and/or inconvenient ciple that all school children in a given commupublic transportation, and limited finance to cover cost of visits, especially nity should learn together, so far as is practito San Pedro and Caye Caulker. Accal, regardless of their handicaps or difficulties. cording to NaRCIE’s 2010-2011 annual (UNESCO, 2002) report there were 1783 referrals and 770 clients. Clients are children who have been assessed by an IRO and referrals are those who have been referred to NaRCIE by a school but have not yet been

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assessed. This means that for the school year 20102011, less than 30 percent of all the children with ELNs in the country got service from NaRCIE including those children with ELNs who are not attending school. See Table 7.1 and Figure 7.1. According to the manager of NaRCIE the level of coverage has declined over the last five years. For the 2010-2011 school-year NaRCIE staff did 111 educational assessments. At this rate it would take 16 years to assess all the current 1783 referrals. In the same school year NaRCIE made 1325 school visits to 347 schools. Given that there are a total of 568 preschool, primary and secondary schools, they have visited 61.1% of all school and visited these schools on average 3.8 times for the year.

The IRO responsible for Western Cayo district supervises 93 clients and has 56 referrals in 21 primary and 22 pre-schools.

assessed as early as possible as to the extent and nature of their disabilities and offered appropriate treatment.

NaRCIE’s IROs also do home visits to locate children referred with ELNs, to educate parents on the importance and right of their child to receive an education, to assist parents in completing referral forms, and to provide stimulation activities, materials, and equipment (e.g., wheelchairs) for children. See Table 7.2. In NaRCIE’s 2010-2011 annual report NaRCIE’s manager highlighted that these visits also help to build “trust-based relationship that helps to distill the fears parents may have concerning whether teachers, students and the general community will accept their child.” (p. 12)

The ELNs NARCIE work with are identified within the following thirteen service categories: Attention Deficit Disorder / Attention Deficit-Hyperactivity Disorder, Autistic Spectrum, Deaf/Hard of Hearing, Emotional / Behavioral Disorder, Gifted or Talented, Health Disorder, Intellectual Impairment, Learning Disability, Pervasive Developmental Disorders, Physical Disability, Foundation Deficit (Slow Learner), Speech/Language Disorder, and Visually Impaired. A child who is suspected by his teacher to be ELNs is referred to the principal of the school who places that student’s name on the referral list for the IRO who will assess the child. Parents are important partners in ensuring that all Unfortunately, because of the number of schools children with disabilities enjoy all their rights. This an IRO has to service, the limited number of visits is highlighted in the SitAn for Children and Women to a school and the number of children already on in Belize 2011 as follows. the referral list, a student might takes months to be assessed. In cases where child needs to see a docParents are also required by law under the Famitor, the IROs would make special arrangements with a doctor on behalf of the parents for the child to be medically ex“Families are expected to provide priamined. Referrals to NaRCIE mary care and protection for children are also made by CNAs.

with disabilities; however, inadequate access to resources, lack of training and support and inadequate public awareness on the rights and capabilities of these children results in many children with disabilities being neglected, stigmatized and denied their rights.” (p. 92)

lies and Children’s Act 173 to take appropriate steps to ensure that children with disabilities are

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Once the student is assessed he/she becomes a client and the IRO assists the teacher to make modifications to teaching plans and programs to make them relevant to the diverse learning needs of students. If the student is not already in school, placement is sought for him. Then the IRO sees the client for a brief time (15 to 20 minutes) during his/her

Table 7.1: Coverage of Children with ELNs by District

(Serving)

Referrals

(Awaiting Services)

Total

Percentage Served

Corozal

157

39.5

Orange Walk

187

263

28.9

Belize

361

1236

1597

22.6

Cayo

111

160

271

41.0

Stann Creek

159

47.2

Toledo

106

80.2

Total

770

1783

30.2

District

Clients

Figure 7.1: Coverage of Children with ELNs by District

1500

Referrals

1000 500

Clients

C nn

St a

To le d

o ay C

iz e el B

al k W

ng e ra O

oz a

Number

2000

District

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Table 7.2: Home visits made by NaRCIE and CARE

Organization

Number of Home Visits 2006

2007

2008

2009

2010

NaRCIE

116

228

CARE Belize

590

697

731

729

813

monthly visits to the school but works more with the teacher than the student. However, IROs are not always able to make their monthly visits to schools because of other unplanned assignments that emerge during a month and other reasons discussed before including finance and transportation. This means that principals, teachers, children and parents don’t get the optimal number of follow-ups to monitor and evaluate their progress, motivate them, and plan future activities. It is therefore critical that teachers are able to effectively continue providing an enabling environment for the children when the IRO cannot visit the school In cases where the child needs assistance beyond the school, home and NaRCIE, referrals are made

IROs consider themselves as nutritionists, educators, social workers, counsellors, advocates, psychologists, health educators, etc.

to the appropriate government, non-government organization, community-based organization and/ or faith-based organization. For example, a blind child would be linked up with the Belize Council for the Visual Impaired (BCVI) for equipment and training for teachers. In extreme cases the student needs cannot be met by a regular school. Some teachers are very conscientious in provid-

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ing service for children with ELNs but many of them are not. There are teachers who would leave students to just “exist” in their class, that is, they would not make special provision to meet their individual needs. Teachers, principals and NaRCIE’s staff attribute this neglect to large class size, the need to cover the school curriculum, and the perception that it is more work to deal with these students. IROs observed that teachers work well with students when they become clients of NaRCIE. They believe that teachers have an intrinsic desire to help children but this is sometimes compromised when there are conflicting objectives like passing exams. They also recommend that teachers be trained in special education methodology at the associate and bachelors levels to be better able to provide minimum services to students with ELNs. In-service training is provided on a continuous basis for teachers because all teachers are getting students with ELNs in their classes and some of them are not trained to deal with these students. All the 21 schools visited in this study had at least one teacher that received training through one of NaRCIE’s 68 training sessions in the 2010-2011 academic year. The attendance at these sessions ranged between 10 and 35 teachers with an average of 25. In these trainings and in NARCIE’s interactions with teachers and principals, NaRCIE strongly advocates that teachers should create conditions to accommodate students’ diversity and facilitate the learning of all children. One of NaRCIE’s Five Year Plan (20102015) twelve outputs is for ‘Increased number of teachers trained at the pre-primary, primary, and secondary levels through improved quality of training programs and services.’ Three of the activities outlined by the Plan to achieve this output are: (a) to devise relevant program standards

and teacher/graduate profiles, (b) standardize core curriculum for initial teacher training programs and revise curricula as needed, and (c) develop and operationalize standards, criteria, policies and procedures to determine courses/ programs/ services that quality as Continuing Professional Development (CPD). Training is also provided to parents so that they can complement the work of the school. In 20102011 academic year 243 parents received training in 11 training sessions, with at least one in each district. The average attendance at these sessions was 22 which was considered to be fair because for some sessions there could have been more parents in attendance. A training could be offered because a school requests a training session for a class to educate parents in order to accept a child with a disability in the class. To build awareness that people with disabilities can work and have families, NaRCIE published a 2012 calendar. This was the second calendar that was done. The first was in 2010. It was done with the Unit’s resource so distribution was limited.

7.3.4 Transition from Primary School to High School Parents are encouraged to send their children to regular high school and alternative education programs offered by YWCA, YES, and ITVET. If they do, NaRCIE’s IROs visit the schools to support students and teachers. NaRCIE advocates for a transition plan for children when they reach twelve

years to prepare them to enter the world of work. The plan is developed by the parent, the teacher, and the child. Parents’ inputs are critical because they have network in the community that they can tap into to get employment for their children. According to NaCIE “there are children who, at some point in their lives, may need a special education program that is completely outside the purview of the regular classroom.” Therefore special centers are needed to provide customized educational services to meet the individualized needs of some students. Justifications for special educational programs also include the following in Box 1. However, even though there is an open door policy for admission to these special schools and centers in Belize, there capacity is miniscule to the number of students who need the service. Children cannot be denied admission to these institutions because of not being toilet trained, lack of language, aggressive/unwanted behaviors, lack of mobility or use of wheel chair, lack of school fees, and lack of parental support. Many activities are organized at the school, community, district, and national levels to afford children with disabilities opportunities to socialize, become involved, and develop their self-esteem. These include Disability Awareness Competition (local, district, national), Special Olympic Games (local, district, national, international), Spelling Bee for the deaf (zone, district, national), festival of arts, workplace observations, and on the job training.

Box 2: Some Reasons for Special Educational Programs

• Some children with disabilities need highly specialized skills taught by specially trained teachers in order not to become handicapped. • Some children with disabilities might never respond to the demands of an academic curriculum and will require alternatives. • Some children with disabilities have a greater opportunity to succeed in special education classes/schools/centers because there is greater emphasis on parental partnership, parental cooperation and active parental participation in the education of the child. • Some children with disabilities need a pipeline of services that begins with special education and proceeds through all manner of social agency and su port services that may extend throughout life.

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7.3.5 Examinations

7.3.6 Collaborations

Systems are in place for all children with disabilities (e.g., physical disabilities (cerebral palsy, spina bifida, muscular dystrophy, arthritis), visual impairment, hearing impairment, specific learning disabilities, medical or personal problems, and temporary disabilities) to sit national and international examinations including PSE and CXC. All schools should have a copy of the Ministry of Education’s guidelines for sitting national exams entitled “Guidelines for the Provision of Special Arrangements in National Examinations for Candidates with Special Education Needs.” This document was approved in 2006. The process for a child with disabilities to get assistance to sit the PSE and CXC starts with the Principal of the child’s school completing an application form for the child which goes to the Examination Unit and is then passed on to NaRCIE for assessment and recommendation. NaRCIE makes recommendation if and what kind of special assistance is to be given to the child. Over the last five years the number of application and students receiving assistance to sit the PSE has increased each year and for CXC there was only one applicant. See Table 7.3

NaRCIE collaborates with several other departments in the Ministry of Education, other government ministries, NGOs, FBOs, and CBOs. The main collaborators are the Examination Unit in the MoE, district education centers, ITVET, Ministry of Health, Ministry of Human Development, BCVI, Belize Association for Persons with Diverse Ability, Belize Mission Project, and CARE Belize. NaRCIE does not have the wherewithal to provide the required services to its clients so it relies on support from other national and international organizations. For example, some deaf children would get tested and hearing aids from Belize Mission Project, those with physical impairments would get wheelchairs from CARE Belize, and those with visual impairment glasses from BCVI.

In 2011, 143 students were referred for special arrangements to sit the 2011 PSE of which 64.3% were accommodated. Some of the ways these students were accommodated include extra time, readers, frequent breaks, separate rooms, and sign language interpreters. There is no extra cost for a child to receive special arrangements.

7.3.7 Challenges Many children with ELN are not being reached by NaRCIE and some of those who are, are not receiving optimal services because of the many challenges of NaRCIE. Some of the challenges cited by teachers, principals, IROs in interviews with the author of this document and are documented in its 2010-2011 Annual Report include the need for: more IROs, greater public awareness of its work; a well designed database to properly document students with ELN; updated equipment for officers (e.g., computers, printers); additional staff such as psychologist, speech/language therapist, physical and occupational therapist; greater parental involvement and collaboration with other agencies; and improved and consistent access to transporta-

Table 7.3: The number of applicants for special assistance to sit the PSE and CXC 2007

2008

2009

2010

2011

Received Assistance

Total Applicants for Assistance

121

143

Received Assistance

Total Applicants for Assistance

PSE

CXC

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tion. IROs are not reimbursed in a timely manner for transportation cost when they travel to school. They are only sometimes provided with transportation or with gas to facilitate getting to the schools and families. The total budget for this critical department for the 2010-2011 academic year was only $484,483. The manager said it needs at least $950,000 to ensure an equitable and acceptable level of services for children all over the country. This will require the services of two IROs in each district and an improved transportation system for IROs. Plans to improve access and quality of service to children with ELNs for the period 2010-2015, according to NaRCIE Five-Year Plan, include expanded access to high-quality early childhood education, increased equitable access to quality and relevant curriculum at pre-primary, primary, secondary, and technical/vocational levels, and improved performance in English, mathematics, Spanish, and the physical and social sciences by students at primary and secondary levels.

7.3.8 Stella Maris Stella Maris is one of the two special schools for children with disabilities in the country. It was established in 1958 to provide educational services to children with physical, sensory, and intellectual disabilities. The enrollment has grown from less than fifty in 1980 to 136 this school year. Most of these students are boys (73.5%) and is mainly attributed to males having a greater propensity than girls to be affected by the disabilities they have. Only children who are recommended by NaRCIE after an assessment are accepted to Stella Maris. Recommendations are based on the principle that this school is the best environment for the child to develop intellectually. The schoolâ&#x20AC;&#x2122;s mission is â&#x20AC;&#x153;to provide the opportunity to its students to learn academic, daily living skills, personal and social skills, occupational knowledge and specific vocational skills necessary for attaining the highest level possible of economic, personal and social fulfillment.â&#x20AC;? Its current enrollment is comprised of learning disabilities, intellectual challenge, deaf, autism, physical impairment and visual impairment as shown in Figure 7.2. As part of its strategy to achieve its mission the school adopted the life Centered Career Education (LCCE) curriculum, exposes children

to some level of vocational skills (in woodwork, home-economics, needlework, art and craft, jewelry making, cosmetology, computer, and agricultural science), maintains a feeding program, and offers transportation and physiotherapy services for its students. A major challenge the school faces is disciplinary problem with children who are brought to the school when they are eight or nine years old. The Principal felt that if some of these children were given help at home, preschool, and primary school they would not need to be in Stella Maris today. As mentioned elsewhere, a declining number of parents is still ashamed of their children with overt disabilities so they wait until the child is seven years or older to bring them to school. In some cases they try to wait for the child to develop to a physical size comparable to others who would be in their class. Another challenge for the school and its administrators is what do the children do when they leave Stella Maris. The principal said her heart aches because the children have nowhere to go after Stella Maris. She also said that approximately five percent of the students who do job training get hired by the businesses or organizations at which they did their supervised occupational training. Most of the others would stay at home and do chores they can handle around the house. The school did job placement in the past and according to the Manager of NaRCIE the school needs a staff member assigned to work with the community to secure jobs for students exiting the school. Efforts have been and continue to be made to provide opportunities for graduates to continue their education by learning a skill to be gainfully employed by someone or to be self-employed. An IRO from NaRCIE works with these students and liaises with ITVET to accommodate these students. But the current challenge is that the graduates of Stella Maris cannot cope with the standards of the ITVET programs which are regional standards. The female graduates, however, continue to access programs offered at the YWCA. The school also is currently operating above physical capacity and is using a borrowed neighboring facility to house its post primary class. The Principal is a proponent of inclusive education but believe that the country is not fully ready for total inclusive education because the system does not yet have

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Figure 7.2: Disabilities and special needs of students currently enrolled at Stella Maris 2009

Physical Impairment 9% Visual Impairment 1%

Learning Disabled 37% Deaf 15% Intellectually Challenged 26% the wherewithal including trained teachers, classroom support, and physical accessible classrooms for children with physical impairments. Some principals prefer to send their intellectually challenged students to Stella Maris because it means less effort by their teachers to assist and support these children and these students will not “make the school looks bad” on the BJAT and the PSE. So the Stella Maris is getting more requests for children who are slow learners but they are being declined after the assessment by NaRCIE.

7.4 Fourteen to Under Sixteen There is a need for something that children can do so they transition from school to the legal employment age of sixteen. Businesses need to be lobbied to give persons with disability a chance to work. Students with intellectual disabilities typically don’t go to high school. Children from Belize City will soon have the option for an evening program at

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Magazine Road in different vocations. NaRCIE is preparing a list of alternative schools (e.g., Tubal Trade and Vocational, 4-H, Belize Global Outreach, Friends Boy School, Living Hope) to share with all special education centers and primary schools to help facilitate children with disabilities accessing post primary education. Children are encouraged and facilitated to attend YWCA and ITVET but because IVET is following the regional standards it is now not as accessible for children with disabilities because of the school’s academic standards.

7.5 Sixteen to Under eighteen Children with disabilities who leave high school before they reach the age of eighteen years and have no employment stay at home. Those who can help with chores do so and those who cannot help them-

selves watch television most of the day and are cared for by their parents. A concern for the children, who are care for by their parents, is who will care for them when their parents pass.

7.6 Eighteen and older Belize Assembly of Persons with Diverse Abilities (BAPDA) BAPDA was formed in 2009 to advocate for the rights of persons living with disabilities. As a fledging organization it networks with CARE Belize and teachers and also liaises on a regular basis with the Belize Building Authority, Traffic Department, Human Development Department, and other organizations. It is perpetually increasing it awareness activities through collaborations with other organizations like Oceana Belize and UNICEF. One of its major current activities is advocacy for ramps to access public buildings. BAPDA receives $200 monthly from the Human Development Department since June 2011 and there are plans to register the group soon. This organization has great potential through its active membership to advocate for the rights of persons living with disabilities. A concern of BAPDA is that many persons with disabilities are living below the poverty line. Some examples are older male persons moving around in wheelchairs begging in Belize City.

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NGOS THAT SUPPORT CHILDREN WITH DISABILITIES Many of the district and national organizations that support children with disabilities were formed in the last five to ten years (e.g., SCAP â&#x20AC;&#x201C; 2008, Office of the Special Envoy for Women and Children (2008), BAPWDA (2009)) and their main functions include helping children with disability to attend school, building awareness and providing opportunities for children living with disabilities. All the organizations that provide tertiary healthcare have international affiliations and provide mainly surgeries which are not done in Belize so the children would have to travel to the United States of America and elsewhere. Without these organizations these approximate fifty children annually would not live a fulfilling life.

8.1 CARE Belize Community Agency for Rehabilitation and Education of Persons with Disabilities (CARE) started as a pilot in Toledo district in 2001 after government decided to divest the Disability Services Division (DSD) of the Ministry of Human Development in 2000 and transfer its services to the private sector. Screening and some of the other services offered by the DSD are now not offered at the level it was under the DSD (IDEM 2004). CARE Belize has provided services to persons with disabilities throughout the country of Belize for nine years. From its inception up to 2006 it provided interventions only to children from birth to six years. Today it has expanded with offices countrywide and supporting all persons with disabilities. From its origins, the services it provided is the widely WHO recognized Community Based Rehabilitation Strategy (CBR). Based on this strategy, CARE has targeted the five main areas which are essential in improving the quality of life of PWD; namely, Health, Education, Social, Livelihood, and Empowerment throughout the country.

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Currently, CARE directly supports approximately 340 clients which represent less than 10 percent of all children with disabilities in Belize. Approximately 175 of these clients are active with approximately 30 in each district. See Table 8.1. Table 8.2 shows the visits RFOs made to homes over the last five years. The CBR strategy allows rehabilitation field officers (RFO) who work with newborns to identify visible disabilities, e.g., clubfeet and spina bifida, and offer early stimulation. Cases are referred to CARE by Rovers who work closely with their communities through attachments with the Community Parenting (COMPAR) in the Department of Human Services. CARE also gets its clients from referrals made by parents, hospitals¸ and schools. According to the RFO responsible for the Stann Creek district, she is covering approximately 50 to 75% of children with disabilities. FOs’ goal is to see each client once per month. This is not happening mainly because of transportation. They see more children in rural than urban areas which might be explained by some children accessing services in Belize City and Chetumal. CARE offers its services under the principles of working with the community and using a holistic approach. In working with the community, when a child needs assistance from someone to move around or to administer a treatment, a mother, other immediate family members and members of the community, are taught how to assist the child. The holistic approach to dealing with rehabilitation is addressing all the individual’s needs, which is similar to the approach called for by the Convention on the Rights of the Child (CRC), which Belize

ratified in 1990. For example, if a child with disabilities is from a poor family, CARE works with the family and other agencies to help address the economic needs of the child by helping the family. A project with the caption “Bridging the poverty gap of persons with disabilities and their families through sustainable micro-enterprise projects involving the community, local credit unions and government ministries to promote social and economic inclusion of persons with disabilities in Belize” that is being planned epitomize this modus operandi. CARE also lobbies with agencies when schools are being built to have ramps and they also train teachers in rural and urban communities to support children with disabilities. CARE also provides low cost adoptive aids, e.g., walkers, special fittings for bathroom and desks for children with disabilities and conduct training workshops for teachers and parents on topics such as spina bifida, mental retardation, and policies for inclusive education. There was a formal training in October of this year for teachers, parents and community members in Belize City on caring for children with disabilities. This training was the first one for the academic year. The major challenge to CARE is the extent to which it is reaching the majority of children with disabilities. There are several individual success stories, for example the young primary school student Angel Santoya of Chunox Village in the Corozal District whose case brought international recognition to CARE Belize in 2009. Angel has spina bifida and club foot and his community worked to raise funds to assist in building special school furniture’s and

Table 8.1: CARE’s clients by rural and urban areas

Year

No. of Referrals

No. of Clients

Rural

Urban

Rural

Urban

2007 2008

44 53

28 19

191 193

106 97

2009 2010 2011

29 47 NA

22 39 NA

211 203 196

129 154 *118

*San Pedro Field area was closed after volunteer PT returned to United States

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Table 8.2: Home visits made by NaRCIE and CARE

Organizations

Number of Home Visits

2006

2007

2008

NaRCIE CARE Belize

590

6977

a ramp access to the school for him. CARE needs to reach the other approximate 2200 disabilities children zero to eight years old who are now not receiving any help in developing their personal capacity and socializing.

2009

2010

1162

7298

summer camp to prepare students for their upcoming classes at the beginning of the academic school year. At this camp preschoolers are trained in Braille, to listen, to interacting, and other skills.

BCVI started in 1981 to provide eye health care (both primary and secondary eye care services) and rehabilitation services. It offers free eye examinations, and treatments and surgeries are provided at an affordable cost, lower than the cost of services in the private practice (National Eye Health Plan for Belize 2010-2014). Similar to the CARE Belize arrangement with the Ministry of Human Development to offer care to persons with disabili8.2 Belize Council for the Visual Im ties, BCVI and Lions Club have an agreement since paired (BCVI) 1998 with the Ministry of Health to provide ophthalmic services on its behalf. This is done through The Belize Council for the Visual Impaired is one of a National Eye Clinic (NEC) established by BCVI in the most active and impacting NGOs on the lives Belize City and primary eye clinics (PEC) in Belize of children with disabilities in general and on the City, Orange Walk Town, Belmopan, Dangriga and visual impaired in particular. Because of its services children who are blind and visually impaired are attending regular schools. It provides Braille Figure 8.1: Blind and visually impaired and Braille books for children attending school. students in school by level of school There is only one student with visually impairment at Stella Maris School. In the 2010 school year, 50 Tertiary children were enrolled in regular schools around Institutions, Vocational Traning,1 the country as 2 shown in Figure 8.1. The Executive Director of BCVI Secondary believed that apSchool, proximately 60% 5 Primary of these children School, are getting the in34 Blind Std. VI student at St. Peterâ&#x20AC;&#x2122;s School, school support Preschool, OW preparing to sit PSE next year they need. BCVI 8 offers an annual The major constraints of CARE Belize to adequately respond to the needs of children with disabilities are funding and the willingness of parents to refer their children for assistance. CARE receives its funding from Government subvention, CBM (Christ Blind Mission) and Sisters of Charity of Nazareth, UNICEF and local fundraising efforts.

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Punta Gorda. Services are provided to people all over the country including remote villages. According to its Annual Report for 2010, in 2010 it held 801 clinics of which 79 were outreach clinics in the most remote villages in the country. In these PEC clinics 11,104 persons were seen and examined by their optometrists of that 19.2 percent (n=2129) were children. Patients are referred from clinics but not all need rehabilitation. In 2010, 170 persons received rehabilitation services with children receiving priority. A lot of the services provided by BCVI are done through three RFOs (Corozal/Orange Walk (North), Belize/Cayo (Central), Stann Creek/Toledo (South), itinerant teachers, classroom teachers, parents, and volunteers using the CBR approach. According to Mrs. Musa, Executive Director, volunteer optometrists would come from the United States from time to time to provide services to the underserved areas of the country and there are local optometrists who volunteer their services at the PECs. BCVI also works with the business community to identify job opportunities for the visually impaired. BCVI is using its database to understand the causes and evolution of blindness and visual impairment in Belize. It is currently examining the increasing number of children with retinopathy of prematurity (ROP) and is working allowing with Neonatal Unit of KHMH to implement strategies to reduce the incidence of ROP. According to the National Eye Health Plan 2010-2014, there is no national screening program and the exact number of newborn babies with ROP is unknown. One of the four strategic directions of the National Eye Health Plan 2010-2014 is the “Reduction of blindness and visual impairment in children.” A recommendation made to the Executive Director during the interview to collect information for this Situational Analysis was for BCVI to collect data on how many children receive glasses and how many are given free. It was well received. Children in NHI coverage zones are given free glasses through the insurance program. There are some major milestones for BVCI in preventing blindness, maintaining sight, and rehabilitating persons with impaired or loss of vision. Its database is now a part of the Belize Health Information System (BHIS) which helps to tract children and others through the health system and to provide better and more effective services for them. Another milestone is a National Eye Health Plan for Belize 2010-2014 that brings together the views and experience of all stakeholders. BCVI is also participating in

VISION 2020 which is a global initiative to eliminate avoidable blindness by the year 2020 and reduce the prevalence of preventable or curable blindness.

8.3 Red Cross The Belize Red Cross has supported the plight of children with disabilities in Belize since 1981 and implemented two major projects for children with disabilities. One of these projects was the Belize/ Netherlands Red Cross Disability Project that started in 1990. Under this project nine teachers were trained as rehabilitation educators, CBR officers were trained, and a manual was developed by representatives from the Ministry of Social Services, NaRCIE, BCVI, and the Belize Red Cross. A film entitled Enabling Belize’s Disabled Children was also developed as a public awareness tool. Other major accomplishments of this project were the training of teachers to deal with children with disabilities in their class. The other project was an Empress Shoken (Japan) grant of approximate $53,000 earmarked in 2002 and 2003 to help persons with disabilities to acquire income generating skills. According to Longsworth (2006) “Thirty-five young persons, 12-25 years old, were the recipients of skill training and life skills training. An educator who received training in the Belize Red Cross/Netherlands Project was employed as the director for the Empress Shoken Project. Two persons with disabilities, who were accomplished artists in carving and craft work, were employed to support the activities of the Project. Computers, printers, and sewing machines were procured, and paintbrushes and art supplies were bought and distributed to the participants.” Despite all the activities described above the project was not sustainable because of the lack of funding. Currently, Red Cross only support to children with disabilities is providing wheel chairs to those with mobility disability.

8.4 World Pediatric Project (WPP) The vision of World Pediatric Project is “Every child, regardless of geography, will have access to quality, critical care so that they can live full and productive lives.” And it has helped many children in Belize over the last 10 years with a variety of surgeries including orthopedic, urology, general pediatric surgery, neuro surgery, cardiac surgery, plastic and magilo facial surgery, and ophtalanology. Children would not have gotten these surgeries if it was not for WPP.

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The process for a child getting assistance starts with WPP identifying local resources. If there is no available local resource the case is entered into the database and based on the needs of the country a team of seven to nine specialists would come down annually to perform surgeries. The team would work with local hospitals as partners which helps to build their capacity. WPP works with a number of NGOs and GOs such as CARE Belize, BCVI, KHMH, Northern Regional Hospital, Southern Regional Hospital, Project Belize, and Friends of Pediatrics. It also works in seven other countries in the Caribbean and Central America. WPP has many success stories in Belize one of which was highlighted in 2011 is baby Joshua. His story is in Box 3.

interact with each other and to feel valued. Both calendar and Christmas concert were done for the first time in 2010 and 2011and were expected to be annual activities. The largest and most ambitious undertaking for CSN of the Office is an Inspiration Center which will provide services that are currently not available in Belize but some children with financial means access from Centro de Rehabilitacion Integral Quintana Roo (CRIQ) in Chetumal. The possibilities of the Center should be life changing. Children from rural communities who suffer from spina bifida who would normally be able to go to school and do other things in their communities might never walk, but the Center will provide treatment that will give these individuals a chance to walk.

Box 3: Baby Joshua’s story about his chance at life

When one-month old Joshua arrived in Richmond, Virginia two years ago, he weighed only 4 pound and was barely holding on to life. Born in Belize with a condition known as esophageal atresia (incomplete esophagus), Joshua could not receive nutrition and would die without surgery. Joshua’s mother was referred to World Pediatric Project through a partner hospital in Belize. She hoped WPP would be able to save her only child. Joshua was given IV nutrition so he could gain weight before surgery. Several weeks later, his esophagus was successfully repaired by a WPP volunteer pediatric surgeon. What had seemed impossible just months before was now reality: Joshua was gaining weight and learning to take a bottle. Soon after, Joshua returned home with wonderful prospects for a full and healthy life.

8.5 Office of the Special Envoy for Women and Children The Office of the Special Envoy for Women and Children is a department within the Ministry of Human Development but it does not receive a budget or an annual subvention from the Government. Since it started the Office has pursed four major projects targeting the holistic development of the child. The first one was a tour of all children homes and families with disabled children countrywide. Another activity was a calendar that showcased children in situations where their disabilities were not a major feature which helped to build their self-esteem and to develop appreciation for their capacity. A Christmas concert for all children in children’s homes countrywide and Stella Maris gave children an opportunity to

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To date the Special Envoy’s office has raised over a million dollars for the construction of the Inspiration Center. In 2012, UNICEF supported the development of the strategic plan. This strategy forms the basis for further dialogue on disabilities and will be usef for the development of the Inspiration Center. Other planned projects are to make municipal parks accessible to children with disabilities and to have a children intensive care unit at the KHMH and the CSEC. The Office partners with CARE Belize, NCFC, and Special Olympics to achieve its goals.

8.6 Belize Special Olympics The Belize Special Olympics is an NGO that promotes the rights and physical and social development of children with intellectual disabilities through

sports. Its goal is to promote healthy lifestyle through all-year-round sport activities including regional and national games, torch run, and heroes’ award. It also participates in international sports and this year it participated in five-a-side football at Special Olympics in Athens, Greece (July 2011) and in 2009 it participated in the Winter Olympics Winter Games (see Box 4). It is presently working on more children participation and more activities such as track and field, football, floor hockey¸ and bocce with different sports offered at various times of the year. The National Coordinator said to achieve its goals the Special Olympics works closely with Peace Corps, UNICEF, CARE Belize, NaRCIE, and the Ministry of Health. NaRCIE assesses the athletes for regional & international games, helps coordinate trainings for athletes, and serves on various Special Olympics committees. The major challenge in making the organization more successful is having sustainable funding without having to continuously beg.

8.7 Rotary Club of Belize In 1970s member of the Rotary Club of Belize developed the Gift of Life Program that is devoted to provide life-saving heart surgery for children sixteen years and younger. On average fourteen children benefits annually from this Program but potentially twenty-four could if there were more funds. Rotary sponsors one parent to accompany a child traveling to the US for surgery and contributes $3,000 per child to defray his/her travel cost. According to the Gift of Life website and Longsworth (2006) semi-annual clinics are hosted to accurately diagnose and prioritized children for surgery. The clinics offered by visiting cardiologists also “ensure adequate treatment through prescription for even those who will not require corrective procedures and follow-up treatment for each post-survey patient.”

8.8 Parent Support Organizations There is at least one parent support organization in each district of the country with varied levels of activity. The goals of these organizations are to create awareness of the rights of children and to provide support for children with disabilities. They are located in urban areas but have membership from rural areas, except PACSN with all members, from Belize City. These organizations include PACSN in Belize City, PASPNOW in Orange Walk, and SCAP in Stann Creek.

Box 4: Two success stories of Belize Special Olympics2

Briany Staine, a student of St. Catherine Academy, and Romelda Logan, a Special Olympics athlete and a post primary student of Stella Maris School, have both been selected by Special Olympics International from among thousands of applicants from around the world to participate in the Special Olympics GlobalYouth Activation Summit on intellectual disabilities that will be held during the 2009 Special Olympics World Winter Games from 6-15 February in Boise, Idaho -USA. The Global Youth Activation Summit is a new initiative of Special Olympics designed to partner and develop youths with and without disabilities as leaders for fostering inclusion in their schools and communities. Both participants, who are representing Belize as well as the Caribbean, being the only successful applicants from the region, were chosen based upon their dedication and commitment to the Special Olympics movement in Belize

These organizations work closely with BCVI, CARE Belize, Peace Corps, NaRCIE, Stella Maris, Special Olympics, and others. The most active organization seems to be PASPNOW in Orange Walk. It current activities include trying to get a building of its own, conceptualizing a Federation of Children with Disabilities, and providing small emergency loans up to $200 for its members. This group rotates meetings between rural and urban areas and among parents’ homes to accommodate all members.

8.9 Other Organizations In addition to the above organizations there are several others that work for the wellbeing of children with disabilities in Belize by providing mainly surgeries and corrective procedures. Most of these organizations are shown in Table 8.3.

Special Olympics Belize to participate in World Winter Games in Boise, Idaho, Amandala Newspaper 6/2/2009.

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Table 8.3: Organizations that support children with disabilities.

Program/Organization

Location

Activities

The Belize Children’s Project / Rotary Club of Belmopan (Shriner’s Orthopedic Hospital)

Conduct clinics at KHMH, Northern and Southern Regional, and Good Shepherd Clinic in Succotz.

Provide free orthopedic surgery for children 0-18 at Shriner’s Orthopedic Hospital, Illinois, Missouri, USA. Has done 250 surgeries over 27 years of existence. Sometimes parents don’t follow-up for children to be processed for surgery

Jericho Road Foundation International: Hillside Healthcare Center

Eldridgeville, Punta Gorda, Toledo

The organization works closely with CARE Belize to offer service to mobility-impaired patients. In the Toledo District. It receives funding from the United States.

Friends of Pediatrics (in partnership with International Hospital for Children [IHC])

Belize City

Provide opportunities for children to receive tertiary healthcare services in Belize and abroad. IHC is a non-profit organization that facilitates critical surgery for children in Latin America, Central America, and the Caribbean

nSan Ignacio, CayoP

oParents and teachers are educated and trained on ways to reduce stigma and shame associated with disability. It works with CARE Belize’s RFO in San Ignacio to provide physiotherapy services. It recruits international volunteers who are qualified physiotherapist, occupational therapist, special education teachers, and speech and language therapist to provide service to needy children.

Belize Association for the Deaf

Belize City

Self support group for persons with hearing impairment.

Lions Club of BelizeB

eBelize City

Provides office space for BCVI.

Cornerstone FoundationS

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CHILD PROTECTION

According to Ava Pennil, Director Human Services, the Ministry of Human Services does not provide any services specifically for children with disabilities. All its services are available to all children. However, the NCFC that falls under the portfolio of the Ministry of Human Services is responsible for the NPA 2004-2015. The NPA has several targets related to disabilities. Three of them are (i) to reduce the incidence of disabilities in newborns caused by prenatal complications, (ii) to increase the detection, diagnosis, and treatment of children with disabilities, and (iii) to ensure that all children with disabilities have access to relevant education, with at least 60 percent enrollment with the regular school system. NCFC is not an implementing agent but it monitors and evaluates the achievement of the Plan. In the 2010 evaluation of the Plan none of the targets for disabilities were evaluated because, according to the report, there were no data but targets indirectly related to disabilities were evaluated. For example, the target to reduce the incidence of low birth weight (less than 2.5 Kg.) to 3.7% of all births increased from 3.3% in 2003 to 8.8% in 2009 (NCFC 2010). NCFC brought organizations that work on behalf of children with disabilities together in the last year to advocate for the signing of the Convention on the Rights of Persons Living with Disabilities. Now that the CRPDWD has been signed on to by the Government of Belize, NCFC is finalizing a document entitled â&#x20AC;&#x2DC;The Framework for Action for Persons with Disabilityâ&#x20AC;&#x2122;. The document was drafted in 2005. NCFC recognizes the need to have one entity that is responsible for the disabled to streamline efforts to work for children and persons with disabilities. According to the Department of Human Services there are some children in Belize living under adverse conditions which include the following.

Dr. Martin Cuellar, Director, National Aids Commission

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Children: 1.

living with HIV/AIDS or with parents or primary caregivers with HIV/AIDS,

abused, neglected and abandoned by their parents/primary caregivers,

born in prison,

living in home where their basic rights to food, clothing and shelter are not met because their families are poor, and

orphaned.

In the last three years the number of children borne HIV positive has declined to a trickle with cases now only in rural areas where the treatment of the Prevention of Mother to Child Transmission (PMTCT) program is not readily accessible1. All mothers who receive the treatment have HIV negative babies. Children 0 to 8 years old who were born HIV positive or whose parents are HIV positive or have AIDS are discriminated against. The welfare of some of these children is addressed by Hand in Hand Ministries, POWA in Dangriga and Liberty in Ladyville, Belize District. Alliance Against AIDS (AAA), according to its Director, provides education support and care for children living with or affected by HIV/AIDS. It assists children infected or affected by HIV/AIDS by sourcing assistance from Life Line Foundation and Living with Hope Foundation and from fund raising to help them enjoy their basic human rights. The Life Line Foundation provides school supplies and gears to encourage HIV positive children to attend school. Children whose parents are HIV positive also receive donations. The Living with Hope Foundation provides supplies and in some cases tuition for children to attend school, support for home improvement, food, and income generation support. The Director of AAA volunteers to work with the Preschool Unit to train teachers to teach sex education in schools. The National AIDS Commission (NAC) is not an implementing organization and does not affect children who are infected or affected by HIV/AIDS. Hand in Hand Ministries is the NGO that is impacting the largest number of children and families infected and affected by HIV/AIDS. It operates a daycare center with 20 children and a preschool with 10 students on Southside Belize City and of-

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fers outreach services for children who are HIV positive and or have siblings and or parents who are infected in Belize District and Dangriga. Some of the children at the daycare and the preschool also have other disabilities. The outreach program currently reaches 78 children who are HIV positive. According to Nadia Armstrong, the Director of the Outreach Program, the three programs offer by Hand in Hand (daycare, preschool and outreach) impact six to seven thousand people. The outreach program is staffed with two registered nurses and three trained social workers, who provide medications and food for infected children, educate parents, and track these children. Hand in Hand spends approximately $250,000 on these programs and receive $206 a month from government as a grant subsidy. According to Mr. Abel Vargas, the Director of Operations, the organization can serve more children if it had more resources because it would be able to expand to other communities and districts where the service provided by his organization is needed but not offered. Furthermore, the organization is not recognized and adequately supported by government for the services it provides. “Young children are especially vulnerable to adverse consequences of separations because of their physical dependence and emotional attachment to their parents/primary caregivers.” (CRC, p. 8). As a signatory to the CRC, Belize should reduce the number of young children abandoned or orphaned, as well as minimize the number requiring institutional or other forms of long-term care, except where this is judged to be in a young child’s best interests. Despite this obligation and efforts to reduce it occurrences, on average about ten children, eight years and younger in Belize, are separated from their parents/primary caregivers each year and are placed in foster homes or institutions4. These children are separated from their parents/primary caregivers because the Child Protection Service (CPS) and or the Family Court or a magistrate court concludes that for the children to enjoy all the rights they are entitled to under the CRC, they must be placed in another environment. Social workers work with families to stabilize homes and use foster parents and children’s home only after all possible alternative methods of assisting the child have been tried without success (Families and Children Law).

Child Placement and Specialization Services, Department of Human Services.

Some children are neglected and abandon by their parents and need to be placed with foster parents or in a home. The Child Placement and Specialization Services (CPSS) of the Department of Human Services is responsible for placement of these children. Children, five years old and younger, are easy to place in foster homes5. CPSS is currently developing a bank of foster parents. These parents are screened and given training. According to the supervisor of the CPSS, the foster parents they use are committed, dedicated, and caring individuals and children placed in foster homes and institu-

tions enjoy all their rights as per the CRC to the extent that foster siblings are kept together. There are six childrenâ&#x20AC;&#x2122;s homes in the country located in Ladyville, Belize City, Dangriga, Belmopan (2), and Flowers Bank. Children are placed in these homes by a court order. Government operates the home in Belize City which has a capacity for 60 children and currently has approximately 25 children eight years old and younger. The extent this home is operating at the minimum standards and meeting the needs of its clients, needs to be assessed.

Ibid.

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LEGISLATION

The rights of Belizean children are embedded in several international conventions and declarations and national laws, policies and plans. As a signatory to the conventions and declarations shown in Table 10.1, Belize has an obligation to ensure that these legal frameworks are translated into national laws, policies, plans, and activities so that all children enjoy all their rights. The major challenge for Belize to fully achieve the provisions of these conventions and declarations is the lack of resources which is manifested more in rural communities where the population is widely dispersed than in urban communities. For example, children in rural areas have less access to preschool education, services from NaRCIE, and medical services than those from urban areas. In both rural and urban areas transportation is a limitation to get children with mobility impairments to school. For example, at the Special Education Center in Dangriga in 2011 had a bus that was transporting children with disabilities to school but sometimes parents did not have the $.50 to pay the fare. The bus is currently not running which cause some children not to be in school because most parents cannot afford other means of getting their children to school. Another case is a child with Downs Syndrome in San Jose village who is not attending school because he lives more than a mile away from the closest primary school. Legislations exist to protect these children but they are not fully enforced. The Family and Children Act 173 of 2000 assert that â&#x20AC;&#x153;The State shall take appropriate steps to ensure that children with disabilities are afforded equal opportunities to education.â&#x20AC;? (p. 20) According to IDRM (2004) Belize was the only country in the Americas that had no legal protections specifically for people with disabilities and Belize and Guyana were the only two countries without an official definition of disability. Most of the international conventions are embedded in the countryâ&#x20AC;&#x2122;s laws. For example, the CRC stipulates that all children with disabilities have the right to education, training, health care services, rehabilitation services, preparation for employment and recreational opportunities and these rights are enshrined in a general manner in the

Page 44

Belize Constitution and are specifically guaranteed in the Families and Children Act Chapter 173, 2000, and the Education Act 36, 2000 (see Box 5). Box 6 shows the relevant provisions in the Education Act and some of those in the Families and Children Act are presented in Appendix 4.

Article 7 of the CRPD states the following:

Belize signed the CRPD in 2011. This convention has provisions specifically for children with disabilities, most of which are already mandated in the National Policy for Persons with Disabilities which was drafted in 2005 but has not yet been ratified, in the National Plan of Action for Children (20042014) and the National Eye Health Plan for Belize 2010-2014.

“Governments agree to take every possible action so that children with disabilities can enjoy all human rights and freedoms equally with other children. They also agree to make sure that children with disabilities can express their views freely on all things that affect them. What is best for each child should always be considered first.” (p. 82)

Table 10.1: International Conventions and Declarations International Agreement

Ratified/Signed

The Standard Rules on the Equalization of Opportunities for Persons with Disabilities - Rule 6 Convention on the Rights of the Child (CRC)

1990

The World Conference on Education for All1

990

Education for All (EFA) The Managua Declaration1

1990 993

The Salamanca Statement and Framework for Action for Special Needs Education

1994

The Dakar Framework of Action

2000

Meso-American Project of Cooperation (Education Attention for Minors with Disabilities), (Special Education)

2001

World fit for All 2002

2002

The Convention of the Rights of Persons with Disabilities (CRPD)

2011

International Labor Organization Convention on Employment and Occupation Discrimination

1999

CAMRODD’s Blueprint for Action CAMRODD – Caribbean Association for Mobilizing Resources and Opportunities for People with Developmental Disabilities

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Box 5: Article 23 of the Convention on the Rights of the Child

1. State Parties recognize that a mentally or physically disabled child should enjoy a full and decent life in conditions which ensure dignity, promotes self-reliance and facilitate the child’s active participation in the community. 2. State Parties recognize the right of the disabled child to special care and shall encourage and ensure the available resources to the eligible child and those responsible for his care. 3. Recognizing the special needs of disabled child, assistance shall be provided free of charge, wherever possible and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreational opportunities in a manner to the child’s achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development.

Box 6: Education laws related to children with special needs

The Education Act 2000, Part VI – Section 25-1: “The Education system shall ensure equitable access for both genders to all educational levels, shall be sensitive to the particular needs of the female gender and shall cater to the special needs of challenged pupils.” The Education Act 2000, Part VI – Section 25-2: “Schools shall be free of gender, racial, or other biases, and shall be maintained in such a way as appropriate.” Education Act 2000, Part VI Section 28 (c): The Chief Education Officer in consultation with the council shall with respect to government and government aided pre-schools, and primary schools and secondary school¬:- approve or permit the managing authorities of such schools to approve alternative areas of study in lieu of or in addition to the prescribed areas of study. Education Act 2003, Part VI Section 110-1: No citizen or resident of Belize shall be refused admission to any school on account of race, ethnicity, language, political affiliation, region of the country of origin, special needs or because of perceived social and economic status. Education Act 2003, Part VI Section 112-2: The education system on the whole, and schools in particular, shall take into account the needs of challenged students and shall provide schools with learning environments to address those needs, including teacher.

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Belize has not yet signed on to the Inter-American Convention on the Elimination of All Forms of Discrimination Against Persons with Disabilities and the ILO Vocational Rehabilitation and Employment Convention. Other countries in the Caribbean have signed on to and/ or ratified these two conventions. The Dominican Republic is the only Caribbean country that has ratified both conventions. Ratifying a convention makes it legally binding to the ratifying State and signing of a convention indicates the support of the country for the principles of the convention. There are provisions in the conventions that Belize signed on to and or ratified that are not reflected in the country’s laws. Owen (2003) made the following observation: “Unfortunately disabled children have been largely overlooked by the laws of Belize (notably no mention is made of disability in the Belize Constitution Act).” (p. 7). The only mention in the constitution about disability is regarding discrimination where it states the following in the Part II Section 16 (Protection from discrimination on the grounds of race, etc.) Subsection (3). “Unfortunately disabled children have been largely overlooked by the laws of Belize (notably no mention is made of disability in the Belize Con

In this section, the expression “discriminatory” means affording different treatment to different persons attributable wholly or mainly to their respective descriptions by sex, race, place of origin, political opinions, color or creed whereby persons of one such description are subjected to disabilities or restrictions to which persons of another such description are not made subject or are accorded privileges or advantages which are not accorded to persons of another such description.

The International Disability Rights Monitor (IDRM) (2004) concluded that there are no national laws that specifically protect persons with disabilities. This was further echoed by Owen (2003) in an analysis of the compliance of laws of Belize with the Convention of

the Rights of the Child in which he made the following observation.

“Despite the length and clear importance attached to this Article [CRC], there has been a lack of specific legislation in Belize dealing with the status of disabled children and their rights (to support, health, education, development, training, rehabilitation, recreation and care).” (p. 7)

For NaRCIE and other NGOs and GOs the rights of persons with disability are embedded in Part II – Section 3 of the Constitution of Belize even though it does not specifically mention disability. Part II caption is Protection of Fundamental Rights and Freedoms. Laws have gone from fleeting to specific detailed provisions for children with disabilities to enjoy their rights in the last five years. There are several modifications to the Families and Children Act that are pending ratification including screening, detection, therapy and treatment of a child with a disability, a definition for disabled child, and incl usive education. See Appendix 5. At the next highest level to laws is policy and national plan of the country for which there are a few that currently make provisions for CSN. Stakeholders working for and behalf of children are increasingly discussing the rights and situation of CSN so provisions are accelerating being made in more policies and national plans in Belize. Even though there are no policies for children with disabilities there are other policies that make provisions for CSN. As an example, the draft Early Childhood Education Policy which should be ratified soon has a section entitled ‘Care for Children with Disabilities’ that makes provisions for CSN as shown in Box 7. NaRCIE, which is a government department that is responsible for education of CSN, is mandated to advocate for and facilitate the process for all CSN to receive preprimary, primary, and secondary education. The Five Year Plan (2010-2015) of NaRCIE states that the organization philosophy is as follows.

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â&#x20AC;&#x153;The National Resource Center for Inclusive Education operates on the philosophy that it is the human right of all children to be provided with equitable opportunities to achieve his/her individual best in all aspects of life. These opportunities must be made available in a respectful and conducive environment that will enhance their holistic development and allow all children to maximize their full potential. It is the responsibility of the state to provide the necessary resources to meet the fundamental rights of all children regardless of their differences. The NaRCIE recognizes its response to pupilsâ&#x20AC;&#x2122; learning needs not only as a moral duty but also as a genuine social responsibility and obligation in the development of all children.â&#x20AC;?

Box 7: Aims of the Early Childhood Education Policy relevant to children with special needs 1. Ensure that provisions are made for the inclusion of children with special needs in all policies and programs developed for children. 2. Facilitate the participation of children with special needs in physical education, intellectual, psychological, cultural and spiritual development activities in ways that are developmentally appropriate. 3. Ensure that all new childcare and other public service facilities are accessible to children with physical disabilities. 4. Encourage the establishment of support groups for parents of children with all kinds of special needs. 5. Prioritize the provision of mental health services for all children with special needs. 6. Advocate for the enactment of legislation to eliminate discrimination against children with special needs, in particular orphans and vulnerable children, in the service delivery system, including in the education, health and child protection systems. 7. Promote the establishment and strengthening of child protection systems aimed at enhancing prevention, treatment and care service to children with special needs. 8. Advocate for the development and/or amendment of relevant laws to enable the developmentally appropriate and sensitive treatment of children with special needs. 9. Advocate for the development and enforcement of rules and regulations to govern all forms of substitute care facilities and programs for children. 10. Support child placement services for children who are abused, or orphaned by HIV/ AIDS, at all times using family preservation and non-institutional substitute care as the main strategies for placement. 11. Ensure the establishment of a strong inter-agency and inter-sectoral referral and support network to provide all necessary services to children with special needs. 12. Ensure the development of legislation, if needed, and programs that strengthen relevant agencies so that they can improve the quality and extent of services targeted at children with special needs. 13. Promote innovative programs aimed at families from low socio-economic backgrounds to ensure that their children will not need to be engaged in the worst forms of child labour, or in any labour activity that interferes with their schooling. 14. Promote the mainstreaming or integration of children with special needs issues into key National Strategies, Policies and Program.

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STIGMA AND DISCRIMINATION Under the Families and Children Act 173, it is the duty of any person having custody of a child to use his/her best efforts to protect the child from discrimination. There are several activities to reduce stigmatization and discrimination against children with disabilities in Belize. These include the promotion of inclusive education, activities offer by Special Olympics and others to build awareness and get children involved. There are recommended ways to address persons with disabilities in several publications and on public announcement one of which is made by the First Lady of Belize. There are parents who are shame of their children to the extent that they don’t bring their children out of the home but according to field officers from NaRCIE, CARE, and teachers and principals these parents and guardians are disappearing. In some cases the children are shame of their condition and some are shame of attending Stella Maris School. Two boys who currently attend Stella Maris don’t wear their school uniform until they reach inside the school because they don’t want to be associated with the school when they are on the streets. The Belize Assembly of Persons with Diverse Abilities (BAPDA) is aware of discrimination against persons with disability in the workplace and feels that government should mandate that disabled persons be hired. In schools, children assist their schoolmates with disabled and work and play with them. This was evident in all the primary schools visited.

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FINDINGS 1. Which rights of children (0-18) living with disabilities are unfulfilled and why?

The rights of children living with disabilities that are unfulfilled are education and healthcare because the enabling environment is absent or inadequate for many children to enjoy, especially those living in rural areas. In some cases, the parents are not making the effort to send their children to school. In a few cases, teachers and principals are refusing children with disabilities in their classes and schools. A few parents experience hardship in getting medical care for their children. In some cases, IROs and RFOs make arrangements for children to see a doctor and provide transportation money but in some cases the parents renege on their commitment to take their children. This is most prevalent among the rural Mayan people. There are some teachers and principals who donâ&#x20AC;&#x2122;t want children with disabilities in their classes because their classes have thirty or more students. According to these educators, to give CSN the attention they need would cause neglect of the other students. They believe that the CSN will contribute to a reduction in the schoolâ&#x20AC;&#x2122;s average performance on standardized examinations (e.g., BJAT and PSE) and teaching CSN means more work for the teacher.

2. What

rights of children (0-18) living with disabilities are

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upheld and in what ways?

rural Toledo than in other districts.

All children rights are upheld for the majority of children living with disabilities. The Ministry of Education promotes inclusive education, the Ministry of Health has several programs that promote the health of the child, and the Ministry of Human Development provides service for the protection of the child. The MOH promotes optimal health of a child from the prenatal stage of development. It does so through several programs including Child Friendly Hospital, administration of Tetanus Toxide to pregnant women, treatment regime to prevent mother to child transmission of HIV in HIV positive pregnant women, administration of Iron and Folic Acid to pregnant women, vaccination of females and males against measles, mumps, and rubella (MMR), administration of oral polio vaccine to children to prevent poliomyelitis, administration of Vitamin A (Vitamin Angels Program) to children, and provision of nutrition supplements to women and children at risk of malnutrition.

Children with severe cerebral palsy, who live in rural areas, are the children with disabilities who are most not attending school and accessing medical services.

3. Who are most excluded and who are those that are excluded? Overall, rural children are the most excluded. Children in rural areas have less access to preschool education, services from NaRCIE, and medical services than those from urban areas. Children with physical disabilities are excluded from education because in many instances it is a challenge for them to reach a school and participate in the minimum educational activities. In most cases these children have to depend on several persons to aid them. Children who are deaf are also excluded of a good education because their classroom teacher knows little or no sign language and the itinerant teacher from NARCIE does not visit the school frequently.

4. To what extent does violation of rights show disparities by sex, age, physical ability, ethnic background and geographical residence? Overall most of the children whose rights are violated live in rural areas and are more common in

Violations of rights to education and health care affect all ethnic groups but affect Mayans more than the other ethnic groups because they are located in some of the most remote rural areas and they typically donâ&#x20AC;&#x2122;t make great effort to help their children with disabilities.

What are the causes for this exclusion and violation of rights? 5.

The two most significant causes of exclusion and violation of rights described in number 5 are the lack of transportation for care bearers to reach these children in a timely manner and commitment from parents to ensure that their children get an education and the best medical service available. Other causes, some of which are related to the two describe above, include the following:

i. the lack of commitment from parents to take children to school each day,

ii. the belief of parents that their children cannot learn,

iii. the belief of parents that no one else can care for their child as they do,

iv. the long distance and the rough and hilly terrain children have to travel to reach school when they have mobility impairment,

v. the family claims that they cannot afford transportation for the child to reach a doctor,

vi. the belief of parents that their children cannot be cured or helped,

vii. parents are ashamed of their chil dren so they donâ&#x20AC;&#x2122;t take them outside their

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home to school, to clinics, to doctors, and to socialize,

viii. inadequate awareness of stakeholders especially, teachers, nurses, community lead ers, etc.,

ix. the culture of parents, and

x. inadequate IROs and RFOs to mini- mally service children with disabilities.

What would it take to make systems work for children (0-18) living with disabilities? 6.

For systems to work for children living with disabilities, a national body needs to be established to coordinate all activities of children and persons with disabilities. Services offer through the three line ministries (Education, Health, Human Development), BCVI, CARE Belize and other organizations need to be coordinated. A comprehensive database of all children with disabilities need to be developed and maintained so that no child â&#x20AC;&#x153;falls through the crack.â&#x20AC;?

Children living with disabilities thought that the government could provide more resources for them to enjoy all their rights. Practitioners also shared the same belief and specified that more transportation and personnel are needed to provide timely service to these children. In addition, they thought that the organizations that work for these children must work closely together.

9. What capacities are required to fulfill these expectations and rights? To full these expectations and rights, the parents of these children need to get parenting education and livelihood education and assistance. The personnel of organizations that support children with disabilities (NARCIE, CARE Belize, etc.) need more specialized training to work with these children. Teachers need to be trained to accommodate these children in their classes. To accommodate children in schools who need specialized assistance, transportation and other resources need to be available for itinerant teachers to visit the children.

How enabling is the legal and policy environment?

10. What are the existing knowledge gaps on the situation of children (0-18) living with disabilities?

Belize has signed on to all the relevant international Conventions and Declarations to protect the rights of children with disabilities. These commitments are not yet fully reflected in our national laws. There are, however, some national plans and policies that incorporate aspects of these Conventions and Declarations (National Plan of Action 2004-2015, Early Childhood Development Policy, NaRCI Five Year Plan (2010-2015) etc.).

There is no comprehensive database of all children (0-18) with disabilities in Belize. Studies of children with disabilities in Belize donâ&#x20AC;&#x2122;t provide data that include all children zero to eighteen years which makes it difficult to draw conclusions about all children (0-18) in Belize. It is, therefore, difficult to examine in detail the prevalence of children with disabilities by location, gender, ethnicity, disability, special need, etc.

What solutions do children (0-18) living with disabilities and practitioners perceive to address the violation of rights?

OTHER FINDINGS

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There are three organizations, namely, NaRCIE, CARE and BCVI, with a high presence in urban and rural areas but to a lesser extent in rural than

areas that are working on behalf of children with disabilities. The organizations working directly and supporting children with disabilities realize that they don’t have the wherewithal to provide the adequate service to the children and recognize that children needs the community support to grow and develop to their full potential and enjoy all their rights. They, therefore, all use the CBR approach to rehabilitation. Using this approach, they engage teachers, parents and others to help stimulate and rehabilitate children with disabilities. BCVI is providing outstanding rehabilitation services to all known children with visual impairments throughout the country of Belize. BCVI makes great effort using creative strategies to raise funds and get support to sustain and expand its services offered to children in its rehabilitation program. Early stimulation and orientation and mobility training are provided for 100% of children known to BCVI unlike children with other disabilities that prevent access to education, e.g., intellectual problems and deafness. Most of the rehabilitation services are provided by a dedicated team of RFOs that is continuously being upgraded and are fully supported by management. Parents and children are continuously recognizing and acknowledging BCVI’s exemplary work in testimonials, discussions, and interviews. The author considers BCVI’s rehabilitation program exemplary in the Caribbean region based on the literature and on discussion with individuals who are familiar with the services offered in the region.

Lack of Resources One of the major limitations of all the caregiver organizations is transportation to reach the clients especially those in the rural areas. Another major specific limitation is insufficient personnel to service the needs in the communities. The general major limitation is the lack of financial resources to buy materials to support children, buy fuel and pay subsistence to reach children. If the United Nations General Assembly adopted resolutions on children with disability are to be

achieved, a formal disability structure must be established, and an agency responsible for persons with disabilities must be in place. There is limited collaboration between organizations that are working for children and adults with disabilities. Children are referred to one NGO to another NGO and to government department and vise versa and from NGOs to international organizations. For example, children are referred from BCVI’s and government health clinics to BCVI’s NEC, from teachers to CARE Belize, from CARE Belize to BCVI and to KHMH, and from Human Develop Department to Hand-in-Hand Ministries.

Education Even though the Families and Children Act states that “The State shall take appropriate steps to ensure that children with disabilities are afforded equal opportunities to education” one or two schools have to be coaxed to accept children who are blind and visually impaired and in many cases the teacher is not skilled to adequately guide the individualized intellectual development of the child. One parent expressed her dissatisfaction with the help her child was getting from her teacher and wanted to withdraw her child from school. All children with visual impairments are included in education when they don’t have any other disability or their main disability is sight. However, there are challenges which include untrained teachers to deal with the individualized needs of these children, many classes are not conducive to learning (large classes), lack of parental support in a few cases, and inadequate support from NaRCIE. A major limitation in meeting the educational needs of children is the lack of trained teachers. Most of the teachers are not trained enough to effectively teach their students with visual impairments. A complimentary limitation is the use of an outdated curriculum. NaRCIE does assessment of disabilities for all sectors of the society. It does it to determine if students have disabilities and if so what are the

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needs, for placement in primary school, for admissions to Stella Maris, for special assistance to sit PSE and CXC, and recently it has been getting requests from other ministries of government to asses adults (e.g., in the case that someone is a beneficiary but the personâ&#x20AC;&#x2122;s ability to spend the money is questionable). Most schools are not equipped with ramp, bathroom facilities, furniture and equipment to accommodate children with disabilities. Schools need to be visited more often than they currently do. NaRCIE is visiting only about 61% of all schools and schools are visited on average 3.8 times for the year. In many cases IROs and RFOs work well together. There is no national law that specifically protect the rights of people with disabilities and no national coordinating agency to develop disability policy and national action plan to ensure persons with disabilities enjoy all their rights. Blindness and visual impairment students are attending regular schools in their community. Need for Protocols: There is no protocol to deal with children with disabilities when they are abused, abandoned, or need the service of a caregiver. For example, if an abused deaf child needs the service of a police in a village or in a urban area, how does the child make a report if she/he cannot write?

Health Children with visual impairments receive health

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services as normal children. All cases are identified early at birth, soon after or when they become blind, through BCVIâ&#x20AC;&#x2122;s network of clinics. Rehabilitation services are not provided unless there is a diagnosis of irreversible blindness. In some cases children receive eye surgery. In a few cases children are not physically developed for their age but the specific health reason for this is not known.

Child Protection There is no national law that specifically protects the rights of people with disabilities and no national coordinating agency to develop disability policy and national action plan to ensure persons with disabilities enjoy all their rights. No strategy is set up in case of an emergency for people with disabilities, no subsidies are available for parents of children with disabilities, schools must enroll students with disabilities but are not required to provide assistance, more than 75% of public buildings are not handicap accessible, no system of transportation is wheelchair accessible and there is no national policy for the employment of people with disabilities

RECOMMENDATIONS

The following recommendations are made based on the findings.

1. The government or an organization needs to establish a center in Belize City or Belmopan which offer services of therapists, psychologists, and psychiatrists. 2. The Ministry of Health should expand its prenatal services to rural women. It should also continue to upgrade its services to pregnant women. 3. Belize needs to develop an official definition for disability to help identify individuals who might need special assistance to enjoy their rights and so that accurate data can be collected in a consistent manner on persons within this group. 4. Document success stories of children who grew up through the system and are successful productive citizens. 5. A policy should be developed for all new school building or classrooms should have ramps and bathrooms that are accessible to children with physical disabilities. 6. Develop a GPS plotting of where the children with disabilities are to help plan interventions, diagnose causes, and strategizes for outreach program and activities. 7. A comprehensive database system of all CSN needs to be developed and maintained for planning and evaluation. 8. BCVI should continue its high level of support to children in providing early stimulation and CBR support, developing their orientation and mobility skills, producing Braille materials, and providing specialized equipment to students.

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9. BCVIâ&#x20AC;&#x2122;s strategies and methods in early intervention and preparation for entry into school should be used as a model for the provision of support for children with disabilities other than visual impairment. 10.

The MoE needs to enforce that all children have the right to an education.

11. The MoE needs to make operational the inclusion policy so that schools can and are obligated to accommodate students who are blind and visually impaired. 12. The MoE needs to respond to concerns that services for some students who are blind and visually impaired are not appropriate to address their unique educational and learning needs, particularly their needs for instruction in reading, writing, and composition, as well as orientation and mobility and other self-help skills. Policy guidance on educating students who are blind and visually impaired urgently needs to be articulated and implemented by the Ministry of Education. 13. The Curriculum Plus Skills need to be updated to include recent technological advances and current innovative pedagogical practices. Considerations should be made to use computers and other new technologies in teaching children who are blind and visually impaired. This will help to facilitate the individualized needs and attention these children need to enhance their academic performance. 14. NaRCIE needs to develop a strategy to more regularly and systematically visit and support students who are blind and visually impaired, as well as teachers, principals, and parents. There should be at least three fully trained itinerant teachers of the blind, strategically placed around the country to give support to children who are visually impaired on a consistent basis (weekly). This is not the role of BCVI. 15. Classroom teachers, who have a student with a special need or disability in their class, need to be trained in at least basic methodologies for teaching children with disabilities before they start teaching a disabilities or disabled student. This can be accomplished by attracting teachers to the summer training programs for teachers offered by BCVI and NaRCIE. 16. Methodology for teaching students with disabilities should be included in summer in-service training offered by the Ministry of Education and continued professional development (CPD) credits given to them by TEDS. 17. Teachers who attend summer training courses in teaching children with disabilities should continue to get TEDS credits. 18. NaRCIE should make available the service of its specialists in the other districts via monthly mobile clinics, like the ophthalmologist from BCVI does, to avoid the inconvenience of having to travel to Belize City or somewhere outside of oneâ&#x20AC;&#x2122;s district of residency. 19. Consideration should be made to house NaRCIEâ&#x20AC;&#x2122;s IROs away from the Ministry of Education office in the districts (Corozal, Orange Walk, Cayo, Stann Creek, Toledo) because they are required to perform many other functions in the department restricting them from fulfilling their main duties as an IRO. If the IRO stays at the present location, the role of the IRO must be well defined and streamlined. 20. Success stories of children who grew up through the system and are successful, productive citizens should be documented and shared with others to motivate them. 21. Parents should be trained to teach home-bound children and conduct home schooling to increase access to primary school.

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22. Special programs are needed for parents who cannot cope for whatever reasons with having a child with a disability.

23. Provide information on all the opportunities available to health care especially tertiary medical care that the poor cannot afford. The information should include the name of the organization, the services provided in simple language and contact information. The systematic and sustained distribution of this information should be done by the three line ministries (Health, Education, Human Development) through their relevant departments (Maternal and Child Health &Health Education and Community Participation Bureau (HECOPB); NaRCIE; NCFC and COMPAR), the main NGOs working for children with disabilities (CARE and BCVI) and the associations of parents of children with disabilities.

24. The services and placement provided to a child with a disability must be based on the childâ&#x20AC;&#x2122;s identified special education and related services needs, not on the childâ&#x20AC;&#x2122;s disability. The services of trained IROs are critical to realize this.

25. NaRCIE must ensure that services for students with disabilities are appropriate to address their unique educational and learning needs, particularly their needs for instruction in reading, writing, and composition, as well as orientation and mobility and other self-help skills.

26. NaRCIE and BCVI need to work closely together to offer services to children in preschool and primary school. Similar efforts should be made with all other organizations that work with children with disabilities. Once NaRCIE has fulfilled its responsibilities then perhaps collaboration with BCVI can be effective.

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REFERENCES Barnett, Carla; Catzim, Adele; Humes, Dorla. (2010). Progress Report #1: Report of the National Consultations on Horizon 2030. Memo. Beach J. (2006). Regional Workshop on Policy, Standards and Regulations for ECD Services. Antigua, September 25 – 28, 2006. Memo. Belize Council for the Visually Impaired (BCVI). Annual Reports 2010. Belize Council for the Visually Impaired (BCVI). Annual Reports 2009. Belize Red Cross, Annual Reports (2006-2010) and Strategic Plan (?). Black, R. (2008). The Lancet’s Series on Maternal and Child Undernutrition. Washington, DC. CARE Belize. (2005). Framework for Action for Persons with Disability. CARICOM. Regional Guideline: for Developing Policy, Regulation and Standards in Early Childhood Development Services. CBR Guidelines: Community Based- Inclusive development – WHO 2010 Community Agency for Rehabilitation and Education of Persons with disabilities– Belize (CARE – Belize) Annual Reports (2006-2010) and Strategic Plan (20082012) ECLAC (Economic Commission for Latin America and the Caribbean). (2009). A Further Study on Disability in the Caribbean: Rights, Commitment, Statistical Analysis and Monitoring. (LC/CAR/L.237), Port of Spain, Trinidad andTobago, December. ECLAC (Economic Commission for Latin America and the Caribbean). (2011). A Further

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Study on Disability in the Caribbean: Rights, Commitment, Statistical Analysis, and Monitoring, Port of Spain, Trinidad and Tobago, December. Gillett, E. (2007). National Committee for Families and Children National Plan of Action Monitoring Report for 2004- 2007. NCFC, Belize. Government of Belize. (2000). Families and Children Act Chapter 173, Revised Edition 2000. Government of Belize. The National Plan of Action, for children and adolescents in Belize 2004-2015. International Disability Rights Monitor. (2004). Regional Report of the Americas 2004. Center for International Rehabilitation. Chicago, United States. International Disability Rights Movement Report 2007 (IDRM) Living Standards Measurement Survey (LSMS) 2009. Country Poverty Assessment Team. Longsworth, Laura (2005). The Situation of Children and Women with Disabilities. CARE, Belize. MDG Belize First Report 2005- UNDP and Government of Belize Ministry of Education. Policy and Procedural Manual for Teachers. Ministry of Health & PAHO/WHO. (July 2010). National Eye Health Plan for Belize 2010-2014. National Committee for Families and Children. (1996), Operation Manual for Day Care Providers in Belize. Belize, Angelus Press. National Committee for Families and Children. (2010). National Plan of Action for Children and Adolescents, Monitoring Report 2004-2009. National Resource Center for Inclusive Education (NaRCIE) – Annual Reports (2006-2010). National Resource Center for Inclusive Education (NaRCIE), (2006). Guidelines for the Provision of Special Arrangement in National Assessments for Candidates with Special Educational Needs. Ministry of Education. National Resource Center for Inclusive Education (NaRCIE), (2010). Five Year Plan 2010-2015, Improving Inclusive and Special Education Services in Belize. Owen, E. O. (2003). Towards Complete Compliance with the Convention on the Rights of the Child: An Analysis of the Laws of Belize. National Committee for Families and Children, Belize. PAHO. (2009). Health Systems Profile Belize: Monitoring and Analyzing Health Systems Change/Reform. Washington D.C. Press Release. Special Olympics Belize to participate in World Winter Games in Boise, Idaho, Amandala Newspaper 6/2/2009. Government of Belize, Statistical Institute of Belize and UNICEF. (2006). Belize Multiple Index Cluster Survey, 2006 Key Findings. Statistical Institute of Belize. 2010 Census Report. Stella Maris School. (2011). School Improvement Plan. Towards a Common Language for Functioning Disability and Health – ICF – WHO 2002 UNICEF. (2011). The Situation Analysis of Children and Women in Belize 2011, An Ecological Review. Fer De Lance Productions for United Nations Children’s Fund, Belize, Central America. World Pediatric Project Belize chapter (WPP)- Database World Pediatric Project. (2011). Patient Highlights 2011. Richmond Office,USA. Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development in Belize: An Assessment. Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development Policy for Belize.

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Appendix 1: Persons Consulted/Interviewed

Name Brian Watson Maria Moralez Sheree Gusman Flores Joe Mena Joan Musa Keylita Flota Hilda Nicholson Michelle Reyes Carmen Sebaranes Oscar Santana Juan Vargas Yvonne Davis Yasmini Caliz Abel A. Vargas Ava Pennil Amir Reyes Celas Martinez Dorita Rivas Ermina Escalante Lucia Pena Martha Correa Parents & Teachers Marjorie Parks Abgail Wade Elsa Avilez Erlett Thomas Juanita Cadle Sharon August Elodia Bautista Stephanie DanielsMoody

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Organization Armenia Gov’t Primary School Armenia Gov’t Primary School Armenia Gov’t Primary School Belize Assembly of Persons with Diverse Abilities (BAPDA) Belize Children’s Project (Rotary Club of Belmopan) Belize Council for the Visual Impaired Belize High School of Agriculture CARE Belize CARE Belize Cayo Support Group Escuela Secondario Mexico High School Examination Unit, CXC Examination Unit, Ministry of Education Former CARE Belize Hand in Hand Ministries Human Services Department Libertad Mary Hill RC Primary School Mary Hill RC Primary School Mary Hill RC Primary School Mary Hill RC Primary School Mary Hill RC Primary School Meeting of parents of Santa Elena Special Education Center Ministry of Health NaRCIE NaRCIE NaRCIE NaRCIE NaRCIE NaRCIE National Special Olympic NCFC

Position Principal Parent Teacher President Coordinator Executive Director Student RFO, Corozal & Orange Walk RFO, Stann Creek Member Vice-Principal Local Registrar Principal Education Officer RFO Director of Operations Director Child Special Education Student Special Education Student Principal Special Education Teacher Special Education Teacher

Deputy Director of Health Services (Nursing) IRO, Cayo IRO, Belize District IRO, Belize District IRO, Orange Walk IRO, Orange Walk Manager Coordinator Information Education and Communication Officer

Elodia Bautista Ellajean Gillett

Arlene Moro Elisa Seguro Georgia Matute

Janae Matute Yvette Burks Omar Caberra Yasmarie Garcia Lupita Gongora Magda Rodriguez Juan Novelo Rosa Moralez Gregorio Moralez Guadalupe Poot Princesa Polanco Evanur Cruz Efrain Mendez Ranjel Chan Marilis Chan Carmen Sebaranes Celia Monroy Debbie Reneau Janet Morgan Manuel Medina Ermita Hernandez Laureli Manganilla Dayell Carbajal Amini Uk Elizabeth Vellos Judit Boneyo Joy Westby Milagro Garel

PASPOW Policy and Planning Unit, Ministry of Education Pro World Roaring Creek Nazarene Pri. School Roaring Creek Nazarene Pri. School Roaring Creek Nazarene Pri. School

Roaring Creek Nazarene Pri. School Roaring Creek Nazarine Pri. School Rotary San Jose Gov’t School San Jose Gov’t School San Jose, Gov’t School San Jose, Orange Walk San Jose, Orange Walk San Jose, Orange Walk San Narciso Primary School San Narciso Primary School San Roman R. C. School San Roman R. C. School San Roman R. C. School San Roman R. C. School San Roman R.C. School Santa Elena R C Primary School Santa Elena RC School Santa Elena RC School Santa Elena RC School Santa Elena RC School Sibun River, Cave Branch St. Peter’s Anglican School, O. Walk St. Peter’s Anglican School, O. Walk St. Peter’s Anglican School, O. Walk St. Peter’s Anglican School, O. Walk Stann Creek Association for Person with Disabilities (SCAP) Stella Maris School World Pediatric Project

Founder and Representative Director Volunteer Teacher Principal Parent & Member of the Association for the Inclusion of Persons with Disabilities, Cayo Student Student Program Coordinator Vice Principal Student Principal Parent Parent Grandparent Principal Special Education Teacher Student Teacher Teacher Student Student Parent and member of parent support group Special Education Teacher Vice-Principal – Upper Vice-Principal – Lower Principal Parent Teacher Student Student Teacher Secretary and Treasurer Principal Belize Representative

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Appendix 2: Total Persons with Disability by Type of Disability and sex for Major division

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Appendix 3: Children with Disability by Type of Disability and Sex

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Appendix 4: Children with Disability by Type of Disability and District

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Appendix 5: Families and Children Act 2000, Part II Section 3 to 9 Rights of a Child 3. The principles in regard to children’s rights set out in the First Schedule to this Act shall be the guiding principles in the making of any decision affecting a child. 4. (1) A child is entitled to live with his parents or guardian. (2) Notwithstanding subsection (1) above, where a competent authority determines in accordance with the applicable laws and procedures that it is in the best interests of the child to separate the child from his parents or guardian, the best substitute alternative staying place shall be provided for the child. 5. (1) It shall be the duty of a parent, guardian or any person, with custody of a child to maintain that child, and in particular that duty gives a child the right to(a) education and counseling; (b) immunization;

(3) Parental authority includes the rights, powers and duties which a guardian of the child’s estate (appointed to act generally) would have had in relation to the child and his property. (4) The rights referred to in subsection (3) above include, in particular, the right of the guardian to receive or recover as trustee, for the benefit of the child, property of whatever description and wherever situate which the child is entitled to receive or recover. (5) The fact that a person has, or does not have, parental responsibility for a child shall not affect(a) any obligation which he may have in relation to the child (such as a statutory duty to maintain the child); or (b) any rights which, in the event of the child’s death, he (or any other person) may have in relation to the child’s property. 7. Subject to the provisions of the Labour Act and the District Courts (Procedure) Act, no child shall be employed or engaged in any activity that may be detrimental to his health, education, or mental, physical or moral development.

8. (1) The parents of children with disabilities shall take appropriate steps to

(d) clothing;

see that those children are-

(e) shelter; and

(a) assessed as early as possible as to the extent and nature of their disabilities; and

(f) medical attention. (2) It shall be the duty of any person having custody of a child to use his best efforts to protect the child from discrimination, violence, abuse and neglect. 6. (1) Every parent shall have parental responsibility for his child. (2) Where the parents of a child are deceased, parental responsibility may, on application to the court, and on the recommendation of a social services practitioner, be passed on to relatives of either parent or to any person designated by the court.

(b) offered appropriate treatment. (2) The State shall take appropriate steps to ensure that children with disabilities are afforded equal opportunities to education. (3) A person who (a) does not have parental responsibility for a particular child; but (b) has care of the child; may, subject to the provisions of this Act, do what is reasonable in all the circumstances of the case for the purpose of safeguarding or promoting the child’s welfare.

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9. (1) A court considering any question with respect to a child under this Act may ask the Department to arrange for a social services practitioner or such other person as the court considers appropriate, to report to the court on such relating to the welfare of that child as are required to be dealt with in the report. (2) The report may be made in writing, or orally, as the court requires. (3) If the report referred to in this section is in writing, a copy of such report shall be made available to the child or his legal representative. (4) It shall be the duty of the Department or, as the case may be, any other person asked to furnish a report under subsection (1) above, to comply with any requests for a report under this section.

Appendix 6: Amendments to Families and Children Act 2000 according to Owen 2003

Fortunately, draft amendments to Family and Children Act have been prepared, to better address the situation of disabled children. The draft amendments provide a system for the early screening, detection, therapy and treatment of a child with a disability (s.9B). They also provide, for the first time, a definition of a disabled child and ensure that social workers are assigned to prepare a long term care package for the child, taking into account the childâ&#x20AC;&#x2122;s individual, racial, cultural, linguistic, religious needs or communication difficulties (s.9C). The care package would also include counseling, nutritional support, parenting skills training and career training. With regards to education, the amendments mirror the practice followed in other Commonwealth countries by requiring that disabled children be integrated into the normal school system and provided with the necessary curricula support and teaching aids (s.9M). Where this is not possible, children are placed in special schools which teach them the curriculum that they would have been taught in regular schools and they are allowed to sit the exams available to children in regular schools (9N).

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The amendments also pay credence to Articles 3 and 9 of the CRC by recognizing that the childâ&#x20AC;&#x2122;s welfare is the paramount consideration and that he or she should, in the first instance, remain with the parents, as opposed to being put in an institution (s.9L). Despite the clear improvements, these amendments have yet to become law and there is still a need for a distinct mechanism to oversee the implementation of these amendments. I understand that the Government disbanded its Disability Services Division three years ago. Whilst the NGO (CARE) has taken over the Governmentâ&#x20AC;&#x2122;s responsibility, it has a very limited sphere of operation. Necessary improvements to the law cannot be secured without a wider mandate and more resources from the Government.

Finally, although not strictly disabled, there is an alarming lack of legislation or policies dealing with children suffering from HIV/AIDS. There is a stigma attached to the disease, and children orphaned by HIV/AIDS are often disowned by their family members or institutionalized. They deserve the same level of care as any other child. There is a need for social workers and health professionals to be trained to deal with this issue, and greater effort should be made in considering their placement within specialized homes or within families. I understand that a community-based approach is being piloted in the South Side of Belize, where the Catholic Church has rented a building from the Government to cater to orphans of HIV. This is to be welcomed, and should form a good model for others to monitor and evaluate.

Appendix 7: Data Collection

Instruments QUESTIONNAIRE FOR TEACHERS/ PRINCIPALS OF SCHOOLS 1. When last have you gotten application from a child with special needs to attend your school?

Have you turned away any applicant?

annually?

3. Do you currently have any child with special needs attending your school?

5. this?

For how long have you been doing

If, yes, how many?

Could you do more?

In which classes?

7. Are you collaborating with other NGOs, CBOs, and FBOs?

6. What accommodation does your school have for them? 7.

Do you promote â&#x20AC;&#x153;inclusionâ&#x20AC;?? How?

8. Are your teachers prepared to accommodate these children? 9.

What are their special trainings?

10. Do you get support from your management to support these children? 11. Do you get support from the community to support these children? If yes, what are they? 12. Do you get support from the Min of Educ to support these children? If yes, what are they? 13. Do you get support from NGOs, CBOs, FBOs to support these children? If yes, what are they? 14. How do other students treat these students? Supportive, ridicule, isolate, facilitate, assist, etc 15. How can your school better serve children with special needs? 16. How satisfied are you with the services offered by your school for children with special needs? 17. What education legislations and or policies are you fulfilling in offering education to children with special needs?

QUESTIONNAIRE FOR NGOS, CBOS AND FBOS 1. Which categories of children with special needs do you assist? 2.

How do you assist them?

How many are you assisting annually?

How many are deprived of this service

8. What can be done to curb the occurrence of children with these disabilities?

QUESTIONNAIRE FOR STUDENTS 1.

At what age did you start school?

2. Were you ever turned down by a school? If yes, what was the reason given? 3.

What class are you in?

Do you have friends in your class?

5. Do you feel that the students in your class like you in their class? 6. How do they treat you? Hostile, accommodating, facilitating, isolating, etc. 7.

How does your teacher treat you?

8. Are you happy with the way you are treated by your teacher? 9. Are you happy with the way you are treated by your classmates? 10. What can the teacher, principal and school do to make school a better place for you? 11.

What is your favorite subject?

12.

Do you like coming to school?

Appendix 8: Inventory of Publications Relevant for the SitAn A National Policy for Persons with Disabilities, Belize. (2005, July). This national policy provides a national framework for advocacy, legislation, strategies and activities for persons with disabilities including children in Belize.

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The policy addressed the law, democracy, public awareness, health, education, income security, access, family life, leisure, coordination and a national mechanism. The challenges at that time (2005) are presented for each of the eleven areas follow by proposed future policies. Disability is defined in this document as “… a restriction or inability to perform an activity in the manner or within the range considered normal for a human being, mostly as a result of impairment (World Health Organization Bulletin 2001)”. This will therefore have to be the operational definition used in this situational analysis. There are three principles of the policy – empowerment, inclusion and independence. The objectives are (a) to encourage the improvement of systems for the prevention of disability, (b) to ensure better services to persons with disabilities, and (c) to support the empowerment of the persons with disabilities. The policies include a call on the government to sign on to international conventions relating to disabilities, education of persons with disabilities of their right to make their own vote, putting in place systems to identify persons with disabilities at the earliest possible age, and strengthening and expanding the services provided by the Special Education Unit to name a few. The state is taking on more of the responsibilities for persons with disability in the world with Belize following suit is discussed. This is evident from the international conventions Belize has signed on to (UN Convention on the Rights of the Child [1989] and UN Convention on Disabilities) and the national documents that reflect the rights and interest of these persons including the Families and Children’s Act Amendment 2000 and the National Plan of Action 20042014. Both of these documents address the special needs of children with disabilities. There are also preventive, rehabilitation and treatment services for persons with disabilities coming from the Ministries of Health, Education, and Human Development. Mentioned is made of the Ministry’s of Health increased infant vaccination services and local access to health services as means to prevent disabilities and to better treat persons with disabilities. The Ministry of Education has a Special Education Unit through which a mainstreaming policy is promoted and the Ministry of Human Development through a COMPAR creates awareness of disabilities. NGOs that provide services to persons with disabilities include Belize Red Cross, Belize Council for the Visual Impaired (BCVI), Community Agency for Re-

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habilitation and Education of Persons with Disabilities (CARE) Belize, Belize Diabetes Association, Belize Crippled Children Program, Belmopan Disability Support Group, CayoCAN Disability Support Network, and Friends of Pediatrics. According to the document the 2000 census showed that 5.9% of the total population had a disability and the most common disability was visual impairment (3% of the country total population). The district with the highest percentage of disability was Toledo with 8.4% and the district with the least was Belize with 4.5%. Ageing and poverty are discussed as causes of disabilities.

Barnett, Carla; Catzim, Adele; Humes, Dorla. (2010). Progress Report #1: Report of the National Consultations on Horizon 2030. Memo. This document is important as national document that can help to improve the prevention, detection, treatment and services given to children with special needs over the long run. Specific references are made to children with disabilities in education and health. For example, in education a view expressed in the consultations is that children with learning disabilities remain invisible within the education system. Their needs are not recognized and strategies are not developed to maximize their learning potential. A proposed strategy moving forward was to expand program and services for children with special needs, including those with learning disabilities. Another proposal is to train teachers to manage children with learning disabilities within the classroom setting. The goals of the health sector include the promotion of healthy lifestyles and the use of a life cycle approach for universal access to affordable and high quality healthcare.

Beach J. (2006). Regional Workshop on Policy, Standards and Regulations for ECD Services. Antigua, September 25 – 28, 2006. Memo. The enabling environment ensures the right and assets of all individuals are considered in educating children, including children with special needs. Minimum standard are established to operate and promote inclusive and nondiscriminatory education. Belize Council for the Visually Impaired (BCVI) Annu-

al Reports (2006-2010) and Strategic Plan (2009-2013). Outlines the activities carried out for the year as it relates to the area of rehabilitation, education, eye screening clinics, and surgeries conducted. The reports include both children and adults and are presented using activities and case studies in each area.

Black, R. (2008). The Lancetâ&#x20AC;&#x2122;s Series on Maternal and Child Undernutrition. Washington, DC. This paper presents ways to alleviate maternal and child undernutrition which affect disabilities in children. Many children are disabled by physical and mental effects of a poor dietary intake in the earliest months of life. Some of these children suffer irreversible physical and cognitive damages by their second birthday. According to this article there is substantial evidence linking stunting to cognitive development and school performance. There are many other associations of nutrition and child development.

Cowo, E. (2009). Disability affects all eight of the MDGs, making it an issue central to reduction of poverty. Paper presented to stakeholders. The Director of CARE Belize argues that after eight years of adopting the MDGs there is not much concrete evidence of achievement for children with special needs. The organization works in the reduction of poverty, promoting inclusive education, and promoting gender equity using community based rehabilitation (CBR) among individuals and families with special needs. He recognized the need for greater collaboration among stakeholders (disable, their families, their communities, NGOs, CBOs, FBOs, and government departments and ministries) and more resources for children with special needs to enjoy their rights.

CBR Guidelines: Community Based- Inclusive development â&#x20AC;&#x201C; WHO 2010 This set of guidelines explains the bases for community rehabilitation strategy through a matrix that depicts the interrelationship among Health, Education, Advocacy, and Livelihood. This guide simplifies the

different strategies through empowerment and advocacy of persons with disability. It serves as a rule book to attaining inclusive development of persons with disability regardless of their geographic, social and economic status.

Community Agency for Rehabilitation and Education of Persons with disabilitiesâ&#x20AC;&#x201C; Belize (CARE - Belize) Annual Reports (2006-2010) and Strategic Plan (2008-2012) CARE- Belize Annual reports 2006-2010 provides current data in regards to the number of clients that are participating in any of the five programs offered by CARE- Belize: Early Intervention, Rehabilitation, Education, Advocacy and Income Generation. It provides a detail list of the disabilities of each client including those with multiple disabilities and associated health problems. The reports are aggregated to include the number of visits that the Rehabilitation Field Officer conducts as well as referrals that are made to the relevant entities that can assist. It gives a breakdown of communities throughout the country to give a precise picture of urban rural profile. The report details the information in sections that enclose the clients by gender and specific age groups; it also provides a space to specify all the new referred cases, follow ups and client discharge.

CARE Belize strategic Plan 2008-2011 Using the SWOT analysis and the log framework strategy, this document outlines the main goals and objectives of the organization that would be carried out during the four years. The activities are designed to complement the results in a measurable fashion. The strategic plan is specifically directed in providing inclusive development to persons with disability following the CBR strategy guidelines. The document considers the role of primary and secondary stakeholders as players in the delivery of intervention and service to CARE Belize clients.

UN Convention on the Rights of the Child

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Families and Children Act Chapter 173, Revised Edition 2000. The Families and Children Act is the executing legislation for the CRC and as such has all the laws related to children with special needs. All policy and procedural documents make reference to this Act. For example, the NPA and the draft Early Childhood Policy are reflective of the Families and Children Act. The specific laws pertinent to children with special needs will be extracted from this Act and summarized in a table.

Government of Belize. The National Plan of Action, for children and adolescents in Belize 2004-2015. To meet her international commitments (Convention on the Rights of the Child (CRC), the Millennium Development Goals (MDGâ&#x20AC;&#x2122;s) Education for All (EFA) and the World Fit For Children Declaration (WFFC), etc.) Belize developed the National Plan of Action for Children and Adolescents 2004 -2015 (NPA). The NPA sets standards for the inclusion and participation of children with disabilities in mainstream activities. It has specific targets, strategies and action regarding children with disabilities. The targets are organized in six main areas (education, health, child protection, HIV/AIDS, family, and culture) with most of them related to children with special needs in the health sector. The only target in the education area of the NPA is to ensure that all children with disabilities have access to relevant education, with at least 60 percent enrolled within the regular school system by the year 2015. The strategies/action to achieve this target is to strengthen the capacity of Special Education Unit to provide support to schools nationwide in education children with special needs. In the area of health, five of the six targets affect children with disabilities of which four of them directly affect and one indirect affect children with special needs. The target, that is labeled disabilities and directly affects children with special needs, is to reduce the incidence of disabilities in newborns caused by prenatal complications and to increase the detection, and treatment of children with disabilities. Some of the other health targets have to do with prevention of disabilities through prenatal care and the elimination of congenital illnesses and defects caused by micro-nutrients deficiencies.

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Some targets deal with the services and support for children with special needs. Two such targets are to increase the accessibility and affordability of comprehensive healthcare services targeting adolescents and to increase the accessibility (Adolescent Health) and affordability of mental health services to all children and adolescents and their families (Mental Health). In the area of child protection, four targets (adolescent and abuse, child and adolescent labour, disabled children and adolescents, and social inclusion) affect children with disabilities. Hiii HIV/AIDS and The Family work areas both have two relevant targets. All the relevant targets and their corresponding strategies and action will be presented in a table for easy reference.

Living Standards Measurement Survey (LSMS) (2009). Country Poverty Assessment. The objectives of this study were (a) to identify current extent, characteristics, trends and causes of poverty in Belize and (b) to assess the effectiveness of current policies and programs and their impact on the poor and the vulnerable. The definition of poverty adopted for this survey was wide and included income poverty, lack of basic needs, e.g., water, roads and adequate housing, and lack of wellbeing resulting from the above and from insecurity, vulnerability and inequality. The data show that poverty increased significantly between 2002 and 2009 from 34% to 43%. These increases occurred throughout the country with the exception of Toledo where poverty decreased a little. Toledo had a third of the countryâ&#x20AC;&#x2122;s indigent population in 2009 compared to a half in 2002. Poverty increased for all groups from 2002 to 2009 â&#x20AC;&#x201C; young and old, urban and rural, females and male headed households. Rural residents were more likely to be poor than urban residents. Poverty was also more like to occur in households whose heads are less educated. The institutional analysis showed that a very wide range of social sector and other programs operated by government and NGOs and these generally had favorable public perception. On the nega-

tive side, there were difficulties providing trained and committed staff to rural areas – just where they were needed most. Insufficient inter-agency co-ordination of programs which caused duplication and poor implementation was also reported. According to the report government could have done more by working harder to reduce corruption and the influence of party politics on development programs. The government could have also developed a more pro-active approach to promoting private sector activities. It could have insisted on greater inter-departmental and inter-agency in the design and implementation of programs. Longsworth, Laura (2005). The Situation of Children and Women with special Needs and Disabilities. CARE, Belize. This document will serve as background information for the current situational analysis which will be an update to this document done six years ago. The purpose of the study was to determine the situation of children 0-18 years with disabilities and special needs in Belize. It provided information on available services, coverage, gaps and made recommendation … actions to ensure that disabled children with special needs are exercising their rights and are integrated in the network for early childhood development services. The methodology used was a review of documents including Education for All (EFA), World Fit For children (WFFC), Millennium Development Goals (MDGs), Convention on Rights of the Child (CRC), and NCFC/Belize’s National Plan of Action (NPA) and interviews of public and private organizations and family members who provide services for children with special needs and disabilities across the lifecycle. Attention was directed at issues of access, inclusion and exclusion in the areas of health, education and social services. In addition to interviews with parents, field visits to the homes of families were held to determine the difficulties they experience in caring for this special group of children. Visits were facilitated by CARE Belize during which methods of rehabilitation were observed. Analysis and recommendations were guided by the

goals of the NPA, MDG’s and scientific literature on issues pertaining to legislation, access, inclusion and exclusion, protection, poverty and disability. The prevalence of children with disabilities was estimated to be 13.5 percent but there are limitations with this estimate. One major limitation is parents’ non-disclosure of information on children with disability. The report points to several documents that incorporate the rights of children with disabilities in Belize. These include the Belize Constitution (S.6.1), the Domestic Violence Act, The Families and Children Act 173, and the Education Act. It also makes reference to the UN conventions and international agreements Belize has signed on to including the CRC, ILO Convention No. 182: Worst Forms of Child Labor Convention 1999, ILO Convention No. 156: The Workers with Family Responsibilities, and UN International Covenant on Economic, Social and Cultural Rights 1966. The document discusses the government ministries and department that support children with disabilities including Human Services/Ministry of Human Development, Ministry of Education, National Committee for Families and Children, Ministry of Health, and Karl Heusner Hospital. It also present the work of nongovernmental organizations, namely The Belize Red Cross, Belize Council for the Visually Impaired, CARE Belize, Belmopan Disability Support Group (BDSG), Belize Crippled Children’s Program, Jericho Road Foundation International, Hillside Healthcare Center, Friends of Pediatrics, Cornerstone Foundation, Rotary Club of Belize, and Caribbean Association for Mobilizing Resources and Opportunities for People with Developmental Disabilities (CAMRODD). Consultations with parents during home visits are presented.

The data are analyzed by sector – health, education, and social services. The health data point to the need to promote healthy lifestyles and educating the public on ways to prevent disabilities as strategies that can help to prevent disabilities. This primary prevention strategy is discussed along with secondary and tertiary prevention services. Recommendations are made for this sector that include the following: (a) Develop public awareness pro-

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grams using the print and electronic media through the Health Education and Community Participation Bureau (HECOPAB), (b) Train and retrain health professionals on education and assessment issues for early detection of disabilities. (c) Identify factors in the environment (like pesticides), that can impact on the unborn child and disseminate information. Government is working toward the achievement of “Education for All” (EFA), and the CRC. A major limitation of the education sector cited was the overlapping of services, lack of consultation when curricula are being developed and the overall lack of collaboration. Access to classrooms for different students at primary school, high school and vocational school is limited. Some of the recommendations are: (a) conduct workshops to sensitize teachers on issues of inclusive education (b) adjust teacher training curriculum to ensure practical experience becomes a course requirement and (c) the implementation of building codes to ensure access y children with disabilities. To address the issue of poverty and disability recommendations to promote backyard vegetable gardens to assist patients to enhance their nutritional levels and to lobby for food ration programs for vulnerable groups are made. Another recommendation is to establish formal linkages with CARE Belize and Human Services to ensure that all needy families have access to available resources. Reliable statistics on the number of children with special needs is not exact and the need to develop a system to collect more accurate data and to establish a database was proposed. A national disability survey was proposed. Funding, training, and linkages regarding sustainability were discussed.

National Committee for Families and Children. (1996), Operation Manual for Day Care Providers in Belize. Belize, Angelus Press. This document has a section entitled “Children with Special Needs” which defines ‘children with special needs’ and briefly mention staff needed, programs to suit their needs, and keeping parents informed of noticeable changes. National Resource Center for Inclusive Education

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(NaRCIE) – Annual Reports (2006-2010) and Five Year Plan (2010-2015) NaRCIE has replaced the Special Education Unit in the Ministry of Education. It provides services for school age children and promotes inclusive education. It has data related to the number of children in the education system that have special educational needs including those who are developmentally delayed and intellectually challenged. The reports contain information as to the number of referrals that are made country wide and the number of assessments that are done. They outline the number of children that are participating in regular school settings and those in special education centers. The reports also have pedagogical training that is done in the regular school system.

PAHO. (2009). Health Systems Profile Belize: Monitoring and Analyzing Health Systems Change/Reform. Washington D.C. This document discusses some of the improvements and points to some of the challenges the Ministry of Health experienced during the period 2000 – 2007. The policy, emphasis, are presented, The Ministry of Health emphasis was on primary and preventive care. A steady increase in national vaccination coverage for the period under review has reduced the impact of vaccine preventable diseases. According to the document the MDG targets related to poverty and HIV/AIDS are unlikely to be attained by 2015. The vision statement of the MoH is “We envision a national health care ystem which is responsive to national, regional and local needs, based on equity, affordability, accessibility, quality and sustainability in effective partnership with all sectors of government and the rest of society, in order to develop and maintain an environment conducive to good health”. This would allow for the attainment of all the health targets in the NPA. Some of the specific undertakings and activities that affect children with special needs are (a) the rolling out of NHI to south-side Belize District and the Southern Health Region, (b) the institutionalizing of protocols for the prevention of mothers to child transmission of HIV/AIDS, and (c) and the introduction of

psychotropic drug use protocols. Some of the challenges to realize the vision of the MoH are human resources (limited training capacity in country, inadequate number of qualified professionals, unequal distribution of professionals across rural and urban communities, etc.) financing, and limited access to equipment and technology.

Ministry of Education. (2000). Handbook for Policies and Procedures for School Services. The Handbook for Policies and Procedures for School Services promotes the protection of the rights of the child. It also promotes inclusive education and asks the following questions. •

Do we value all children equally?

•

Is anyone more or less valuable

•

What do we mean by “inclusion?”

• Are there some children for whom “inclusion” is inappropriate? According to the Handbook the education system shall ensure equitable access to education by both genders and shall cater to the special needs of challenged pupils which are consistent with the NPA, CRC and CRPD, etc. For example, under the caption “Facilities and Health Conditions” the Manual states that “schools are encouraged to provide barrier free classrooms and ramp access where possible for the handicapped. Schools should be provided with trained teachers to meet the needs of challenged students and teachers are required to refer students requiring special attention to the school administration. A specific provision is to accommodate special needs students to sit examinations.

with disability, the 2006 MICS state that 26.3% of those aging from 2-9 years have at least one disability and that this percentage increases in the Toledo District reaching an aggravated 50.9%. The data from the MICS needs to be compared to those from the census and other sources for validation because there seems to be discrepancies in some measurements.

The MICS also provides information about health and awareness factors that affect the prevention of disabilities including vaccination, nutrition, and child protection.

Statistical Institute of Belize. 2010 Census Report. The information has been requested from the Statistical Institute of Belize (SIB). This information will provide a good estimate of the number of children with special needs by types of disabilities, ethnicity, location, age, sex, etc.

UNICEF. (2011). The Situation Analysis of Children and Women in Belize 2011, An Ecological Review.

Statistical Institute of Belize, Belize Multiple Index Cluster Survey 2006, v 1.0 and 2010.

This analysis presents detail information in a section entitled “Special Needs Education” about children with special needs. An overarching legislative statement related to children with special needs is quoted from Article 25 of the Education Act which states “the education system shall … cater to the special needs of challenged pupils. According to the 2000 census, approximately six percent of the entire population has some form of disability with the major being sight impairment (27%). Some of the challenges for persons with disabilities cited are that specific legislation that governs their treatment is absent, buildings are not designed to allow access, and public transportation is not accommodating to persons with disabilities.

The Belize Multiple Indicator Cluster Survey (MICS) encompasses information regarding households, women and children. The 2006 MICS was compiled by the Statistical Institute of Belize. The social indicators enable stakeholders to monitor and evaluate progress in human development specifically as how it impacts women and children. In regards to children

The services offer by CARE Belize and the Maternal and Child Health Program in the Ministry of Health are described. The Ministry of Education through The National Resource Centre for Inclusive Education (NaRCIE) promotes inclusive education for children with physical and intellectual disabilities. The Department experiences a lack of trained teachers

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and inadequate resources to optimally execute its mandate. The following organizations work along with NaRCIE. 

The Association for Inclusion of Persons with Special Needs (AIPSN)

 Belize Council for the Visually Impaired (BCVI) 

Community Agency for Rehabilitation and Education of Persons with Disabilities (CARE)



Community and Parent Empowerment

(COMPAR) 

National Committee for Families and

Children (NCFC)



PROBELIZE



Caribbean Agency for Mental Retardation and Other Developmental Disabilities and Delays (CAMRODDD)



United Nations Educational Scientific and Cultural Organization (UNESCO)

NaRCIE classifies the following service categories under exceptional learning needs: • Learning Disabilities • Speech of language Disorders • Emotional/Behavioral Disorders • Health Disorders • Deaf /Hard of Hearing • Visual Impairments • Physical Disabilities • Multiple Disabilities • Autistic Spectrum • Intellectual Impairments • Slow Learner • Gifted or Talented

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Only one reference of children with special needs is made in the Health Chapter of the analysis however statistics on factors that affect the prevention and treatment of children with disabilities are presented. The reference made was that only 13% of schools nationwide have toilets that are constructed to accommodate children with physical disabilities. Data and information presented and discussed are related to the following: more than 95% of children are vaccinated against vaccine-preventable diseases, the increase in the proportion of births attended by skilled personnel, a large percentage of pregnant women (87%) are seeking prenatal care but some are not doing so until their third trimester (11.5%), and the increase in the percentage of children with advanced HIV infection and HIV-positive pregnant women receiving antiretroviral therapy. The challenges of the health system include limited human and infrastructure resources and funding. There is no legislation in place to protect children with disabilities but there is a National Policy for Persons with Disabilities passed by Cabinet in 2005. Belize is also a signatory to the UN Convention of Rights of the Child (CRC), CEDAW, and the UN Convention on the Rights of Persons with Disabilities but has not yet signed onto the OAS Inter-American Convention on the Elimination of all Forms of Discrimination against Persons with Disabilities. The CRC is to be enacted into law through amendments to the Families and Children Act which are in draft for the last eight years. According to the analysis “the rights-based approach to issues relating to children and adolescents that is set out in the CRC has been adopted in all laws passed after the ratification of the CRC in 1991”. Even thought there are international obligations and many national organizations (e.g., CARE Belize, BCVI) and government departments (e.g. NaRCIE) that support the rights of children with disabilities, there is no official body in place to protect the rights of these children. Services to children zero to five are provided by CARE Belize and by NaRCIE for school age children. The Situational Analysis for Children and Women in Belize 2011 describes the services offered by families to children with special needs as follows: “Families are expected to provide primary care and protection for children with disabilities; however, inadequate access to resources, lack of training and

support and inadequate public awareness on the rights and capabilities of these children results in many children with disabilities being neglected, stigmatized and denied their rights.” (p. 92) Article 23 of the CRC “binds signatory States to recognize that a mentally or physically disabled child should enjoy a full and decent life in conditions that ensure dignity, promote self-reliance and facilitate the child’s active participation in the community… Recognizing the special needs of disabled children, assistance is to be provided free of charge, wherever possible and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreational opportunities in a manner that supports the child’s achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development”. (p. 103) Only two (number 12 and 62) of the 70 recommendations of this Analysis made reference to disabilities and they are about building awareness and dissemination of information.

with others, to the physical environment, to transportation, to information and communications, including information and communications technologies and systems, and to other facilities and services open or provided to the public, both in urban and in rural areas. These measures, which shall include the identification and elimination of obstacles and barriers to accessibility, shall apply to, inter alia: a. Buildings, roads, transportation and other indoor and outdoor facilities, including schools, housing, medical facilities and workplaces; b. Information, communications and other services, including electronic services and emergency services. Article 20 - Personal mobility States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by: a. Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost; Article 24 - Education In realizing this right, States Parties shall ensure that:

UN Convention on the Rights of Persons with Disabilities. The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. This is similar to Article 7 of the Convention which is entitled “Children with Disabilities” and states that “States Parties shall take all necessary measures to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children”. The Convention has fifty articles including accessibility, health, education and personal mobility. Excerpts from these articles are shown below.

Article 9 - Accessibility 1. To enable persons with disabilities to live independently and participate fully in all aspects of life, States Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis

a. Persons with disabilities are not excluded from the general education system on the basis of disability, and that children with disabilities are not excluded from free and compulsory primary education, or from secondary education, on the basis of disability; 3.c Ensuring that the education of persons, and in particular children, who are blind, deaf or blind, is delivered in the most appropriate languages and modes and means of communication for the individual, and in environments which maximize academic and social development.

World Pediatric Project Belize Chapter (WPP) - Database World Pediatric Project is an international organization that provides medical and health interventions for children worldwide. It operates countrywide in Belize offering clinics in urology, spina bifinda , general surgery, plastic surgery, ears, nose and throat, and cardiology. The request for a copy of it database

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has being made and it awaits clearance from its headquarters. This database will be combined with others to have the most comprehensive database of children with special needs in Belize. Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development in Belize: An Assessment. This assessment makes reference to the accommodation of children with special needs. According to this document most preschool aged children with special needs are not in preschool because the schools cannot accommodate them. Only a couple preschools have wheelchair access to accommodate children with physical needs. In 2008 a screening program was introduced to screen children for special needs when they enter preschool. Primary school teachers have been trained to do basic screening of children with special needs and all preschool teachers trained in the basic summer training program receive introductory training to work with children with special needs to a limited extent. Children with extreme special needs are referred to NARCIE which works with the schools to make the children fit in as much as possible with the other students. A problem for children with special needs is that their parents are typically in denial and wait until they are older than five years to bring them to a preschool or primary school. The â&#x20AC;&#x153;Handbook of Policies and Procedures 2000â&#x20AC;? for teachers need to include early childhood development issues related to children with special needs. There is currently no disability policy or national action plan. Services for the disabled are provided by several independent organizations including CARE Belize, Stella Marris and NUEI through the Ministry of Education or advocated for by NCFC. However, there is no coordinating body without which, the organizations are not able to effectively lobby the government and other agencies for resources, policies and laws to meet the rights of the children and adults with special needs. According to this assessment the NPA has two targets related to disabilities. They are to reduce the incidence of disabilities in newborns caused by prenatal complications and to increase the detection, diagnosis, and treatment of children with disabilities.

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The work of CARE Belize is described to illuminate the services available for children with special needs five and younger. CARE Belize provides physical rehabilitation services for children from birth to five years old but works with some children until they are six years old. It services on average approximately 30 children in each district or a total of 150 -175, which represents less than 10 percent of all children younger than five years old with special needs in Belize. The service is provided by rehabilitation field officers (RFO) who work with newborns to identify visible disabilities, e.g., clubfeet and spina bifida, and offer early stimulations. Cases are also referred to CARE by Rovers who work closely with their communities through attachments with the Department of Human Services. CARE also provides low cost adoptive aids, e.g., walker, special fittings for bathroom and desks for children with special needs and conduct training workshops for teachers and parents on topics such as spina bifida, mental retardation and policies for inclusive education. CARE Belize uses the Community Based Rehabilitation (CBR) approach to address the needs of children with special needs especially in the rural areas where the services of professionals are not available. The major constraints of CARE Belize to adequately respond to the needs of children with special needs are funding and the willingness of parents to refer their children for assistance. It received its funding from Government, CBM (Christ Blind Mission) and Sisters of Charity of Nazareth. At the primary school level the assessment presents the national targets and services provided. The target of the NPA at the primary education level is the same as that of the preschool level, that is, at least 60 percent of all children with disabilities enrolled within the regular school system. The MoE have an inclusive policy in which children with mild mental or physical disabilities are integrated in regular classrooms. One of the strategies of the NPA to address childrenâ&#x20AC;&#x2122;s with special needs accessibility to school is to strengthen the capacity of the Special Education Unit to provide support to schools nationwide in educating children with special needs. Like at the preschool level, most children 5 to 8 years old with special needs are not in primary school. Some are attending Stella Maris School.

One of the challenges for primary schools to accommodated children with special needs is to have trained teachers who can effectively teach these children and adequate resources. The MoE has adopted a policy of assimilating children with physical and intellectual disabilities in schools. Each year the Special Education Unit of the Ministry of Education does a country-wide program to assess students in schools for learning disabilities by itinerant teachers. The document also discusses UNICEF technical and financial support to the Ministries of Education, Health and Human Development and the limited support system parents have in raising their children with special needs and the challenges they experience. It presents the level of accommodation of buildings and public vehicles to children with special needs.

1. Ensure that provisions are made for the inclusion of children with special needs in all policies and program developed for children and their families. 2. Facilitate the participation of children with special needs in physical education, intellectual, psychological, cultural and spiritual development activities in ways that are developmentally appropriate and inclusive. 3. Ensure that all new childcare, education and other public service facilities are safe and accessible to children and family members, with physical and sensory impairments, through application of universal design principles.

Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development Policy for Belize. This policy clearly caters for the rights of children with special needs. It discusses the need for more support for special needs children to access preschool and primary school, materials to include them in schools as part of the inclusive education policy/ effort, and trained teachers to teach them with all students. The following objectives of the policy are relevant to children with special needs.  To ensure the early detection, prevention, intervention, treatment, care, and services for children with special needs with a clear emphasis on family/ community support and aiming at inclusion in/for all services.  To ensure that disadvantaged children and children with special needs have equal access to quality and inclusive public education, health and social services. There are many policy statements in the document that address children with special needs. Also all recommended activities involve children with special needs and their families as part of the non-discriminatory principle of the policy. Of the six specific activities and targets for implementing the policy, one was specifically for the “care for and inclusion of children with special needs”. Three of the policy statements are shown below.

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