7
	Mobilising Communities in Guyana

	Brian O'Toole

The gap between the need and provision for rehabilitation cannot be closed by developing, or even expanding, conventional services.  Instead a new pattern of services, characterised by fewer experts, less advanced forms of training and simplified methods of intervention, needs to be developed.  The challenge is to find ways of providing the most essential assistance to high numbers of persons utilising the readily available resources. 
	The goal of Community Based Rehabilitation (CBR) is to demystify the rehabilitation process and give responsibility back to the individual, family and community.  Rehabilitation then becomes one feature of community development whereby the community seeks to improve itself.  Once the community takes on the responsibility for the rehabilitation of their disabled persons, then the process could truly be called 'community-based'. In such  a process, rehabilitation becomes one element of a broader community integration effort.  
	The philosophy of CBR is immediately persuasive, but can it be translated into practice?  Is community involvement in the area of rehabilitation realistic?  Is it possible to develop rehabilitation as a 'process', in which a number of persons are involved, rather than  as a 'product' which is dispensed by others?   This chapter examines the way in which the 'Hopeful Steps' CBR programme in Guyana, South America attempts to mobilise the community to assume a sense of ownership for the rehabilitation process.

Guyana: the Country
Guyana is located on the Atlantic shoulder of the South American sub continent.  It is bordered by Suriname on the West, Venezuela to the East and Brazil to the South.  Guyana is a land of 83,000 sq. miles with an estimated population of 0.8 million.  Ninety percent  of the population live on the narrow coastal region.  Guyana achieved its political independence from Britain in 1966, and declared itself a Co-operative Republic along Socialist lines in 1970.  The economy is based primarily on the production of sugar, gold, rice and bauxite.  Guyana's economy is very vulnerable to fluctuations in world trade.  
	An examination of social and economic statistics on the country reveal both positive and negative trends.  Infant mortality is declining, from 69 per thousand in 1960 to 33 per thousand in 1985, and so is the crude death rate, from ten per thousand in 1960 to six per thousand in 1985.  Life expectancy has risen from 60 years in 1960 to 69 in 1985 and is now 12 years longer than the world average.  The picture is however balanced by other indicators. The GNP per capita is falling from the 1982 figure of US$670 to a figure of $590 in 1994.  The percentage of the national budget allocated to health has been  one of the lowest in the Caribbean.
	Guyana has only one special school which is based in the capital Georgetown, and serves the needs of hearing-impaired and intellectually impaired children.  There is a waiting list for entry to the school.  In Georgetown there is also a centre for physically handicapped children and a Unit for visually impaired children is attached to a regular school in the capital.  There are two very small units catering for disabled children in two of the towns in the rural areas.  The capital, with approximately 23% of the population, has 90% of the provision in the area of special education . There is a significant gap between needs and available services.  

The Beginnings of 'Hopeful Steps'
A two year, pilot CBR project was conducted in Guyana from 1986-1988.  Before the project began a series of meetings was held with personnel from the Ministry of Education and Ministry of Health, as well as with parent groups, community leaders and rehabilitation professionals.  
	Arrangements were also made for the training of prospective field-workers to be offered as a course by the Institute of Adult and Continuing Education (IACE) of the University of Guyana.  The CBR programme complements the philosophy of IACE, which is to reach out into rural communities and help villagers to become more active participants in their own development process. 
	A series of radio programmes, newspaper articles and announcements in schools, shops and places of worship helped to prepare the wider community for the project.  A public meeting to introduce the programme attracted more than 200 people in a rural village school.  Sixty persons applied to be trained to work as volunteers with disabled children and their families.  
	From the outset it was clearly understood that the work was voluntary and that it would not lead to formal employment.  In all, 26 of the applicants were accepted as volunteers for the programme. They came from a wide variety of backgrounds including nurses, teachers, clerks, technicians, students and housewives.  All but two of the volunteers were women.  About one fifth of the volunteers had a relative with a disability. 
	Many of the volunteers were already playing key roles in the community as teachers and nurses.  A number of the volunteers were therefore well placed to make a wider contribution to their community. It was not therefore a matter of us taking whoever we could get from the area as volunteers.   The pilot project confirmed that, within the Guyanese context, it was indeed feasible to recruit volunteers  from within the community who could be effectively trained to be of service to persons with disabilities.
	The pilot project lasted for 2 years with the volunteers meeting twice per week to learn about ways in which they could help disabled children.  The majority of the volunteers soon became deeply involved in the project and were eager to meet together to discuss their anxieties, doubts and to share their successes.  A sense of belonging soon emerged and the volunteers came to regard the project as their own.  
	Each of the volunteers worked with one or two disabled children. In each home someone was identified who would work along with the child. The volunteer suggested certain activities to this family member which would help the child to learn new skills.
	One of the key features of the pilot programme was the involvement of the wider community.  A rehabilitation committee  was formed which took  responsibility for the programme.  They approached a local Hindu organisation and created a Resource Unit in their village for disabled children who were unable to attend regular schools.  The Hindus provided the building and the local committee  equipped the unit with material donated by the wider community.  The Ministry of Education seconded the headteacher and two other  teachers to work in the unit. All three teachers were 'graduates' of the CBR programme.  
	The local rehabilitation committee continues to meet on a regular basis to review progress and still oversees the development of the Resource Unit eight years later.  Hence the project continues to be a community-based  model of rehabilitation. 

The Expansion of the 'Hopeful Steps' Programme 
On the basis of the results from the pilot project an expansion of the Guyana CBR programme began in 1989, funded by Amici di Raoul Follereau and the European Commission.  The goal of this phase was to expand and consolidate the CBR programme in Guyana.  The hope was to expand the programme into two new coastal areas of Guyana working through volunteers.  In a third area the goal was to  work through school teachers.  
	A further aspect of this new phase was to explore the relevance of the concept of CBR in one of the indigenous regions of the country.  
	In the expansion phase, efforts were to be made to work more closely with the existing government infrastructure and to explore ways to raise up a new cadre of workers who would be able to introduce the CBR philosophy into new regions of the country.
	Once again the major focus of the 'Hopeful Steps' programme was based around the use of volunteers from the community.  In the two new areas of coastal Guyana in which the programme has expanded, three times as many people have applied to be accepted as volunteers on the new training programme as could be accommodated.  The drop-out rate over the course of two years was no more than five per cent.  The volunteers have proved to be a committed cadre of individuals who have given generously of their time.  Over 70% of the volunteers have remained deeply involved in the programme three years later. The volunteers are generally accepted by the families and have generated a high degree of wider community involvement.  
	It should be emphasised that the 'volunteers' came from a wide cross-section of backgrounds.  Nurses, midwives, and school teachers were well represented amongst the volunteers.  In other cases it was the family members of persons with disabilities who volunteered their services.

CBR Teams in the Interior
The Rupununi region of Guyana is the home to almost half of the Amerindian population of the country who live in a number of very isolated and sparsely populated communities (see Chapter 4).  Introducing the CBR programme in the Rupununi has created collaboration between a number of agencies who share the common goal of empowering communities to help themselves.
	Over the course of eight months a series of five, one week field trips were made by the author to the region. Discussions were held with the local community leaders in ten villages. 
	The main activity of these early exploratory visits was to listen keenly to the people and to try and understand their needs. In each village a public meeting was held to introduce us to the community and to provide a forum for the people to express what they felt were their major needs.  
	The following needs were expressed (the number of villages mentioning each concern is given in brackets)

	 improved water and sanitation (10)
	 training in health and education (8)
		(areas mentioned included: upgrading the skills of Primary Health Care workers and teachers, as well as training more microscopists for malaria detection and dental nurses)
	 education of the community (5)
		(on issues such as alcohol abuse)
	 improved methods of agriculture (4)
	 improved Health Centres  (4)
	 development of kitchen gardens (3)

After three years of the 'Hopeful Steps' programme in the Rupununi region it has been very instructive for us to reflect back on this original list of priority needs to see how many were addressed by this particular programme.   As you read on, you will be able to form your own judgement.

Training Workshops   
It was felt that the greatest contribution our programme could make in the interior was in the raising up of human resources. The major focus of the 'Hopeful Steps' programme in the first three years therefore was on providing training for identified leaders within the community.  Over the course of the past three years a total of 24, one week workshops have now been held in this isolated region.  As in other parts of the country, the training is sponsored by the Institute of Adult and Continuing Education (IACE) of the University of Guyana although this is the first time that the University has had a presence in the Rupununi region of the country. 
	The region, comprising 33 villages, was divided into five sub-regions and over the three year period, a four day workshop was held in each one.  The topics covered in the workshops were as follows:

	Year One: early stimulation, child development, introduction to disabilities, ways to influence awareness within the community concerning disability issues, puppet making.
	Year Two: ways to carry out a survey, toy making workshop, assessment and teaching ideas to promote development in the first 6 years of life, examination of child development from the perspective of Amerindian culture.
	Year Three: leadership training skills, consultation, integration of children with disabilities into regular schools, ways to conduct workshops in local villages 

	Insert Photo 7.1 here 

In addition to the above, a literacy training workshop has also been held in each sub region for all the teachers which focused on the promotion of literacy and numeracy skills in the children. The themes of the various workshops emerged out of the dynamic of the intervention and were not predetermined from the outset.
	Attendance at the workshops has often entailed the participants travelling long distances on foot, by bicycle and by canoe. On three occasions, people have walked for over 13 days to participate in the workshops. 

CBR Teams
In each of 33 villages there is now a team of three persons who constitute the CBR team, namely the Community Health Worker, a school teacher and a village leader. 
	In all the literature on CBR  we read of the need to develop a multi-sectorial approach.  However the number of effective examples demonstrating this are few.  Our hope was to bring educators and health workers together for a common training to develop a unified vision of the needs of their communities.  This was the first time that such  a joint model of training has been undertaken in the region.  
	In addition however the Amerindian communities have a lifestyle and tradition that has evolved over many hundreds of years.  Any intervention that is insensitive to the traditional patterns of leadership would not succeed.  The team were therefore joined in each case by one of the village leaders.  It is always easy to present a coherent rationale for a programme as one reflects on its evolution.  In practice however, there was limited awareness of the goals and objectives of the project at the beginning of the programme.  As such, in some cases better choices could no doubt have been made to form stronger teams.
	However, three years later with considerably more awareness and involvement in the programme, a new model of management has been added.  The expanded model has emerged in collaboration with the Baha'i Health Partnership which has been operating an extensive Primary Health Care programme throughout the Rupununi region over the same period of time. Now the plan is to develop a Village Health Assembly (VHA) in each of the 33 villages in the Rupununi. To date 24 VHAs have been elected by all the adults in the village.  In the elections,  there is no canvassing and no nominations and in each village a very high percentage of the community has turned out to take part.
	The VHAs are now challenged to address the needs of their community. 'CBR issues' therefore become one area of their focus. Already  two day workshops in 14 villages have been held for the newly elected VHAs to deepen their understanding of the challenges facing their community and the need to develop a new style of moral leadership based on service to the community.

Community Development
The work in the Rupununi is  emerging into an integrated  community development project. One example of this is the collaboration on the 'Facts for Life ' project  with the Baha'i Health Partnership that is operating in the region.  All 33 villages  participated in the 'Facts for Life Festival' in which villagers of all ages wrote poems, songs, skits, short stories and produced posters to communicate the essential health messages featured in the joint UNICEF, UNESCO and WHO publication 'Facts for Life' book. The Festival  captured the imagination of the villagers. It proved to be a way of giving expression to their rich culture in order to communicate health messages.  
	Another aspect of the programme in the Rupununi is the promotion of training in literacy. Following one of the early workshops on CBR a request was received from the teachers to develop a literacy training module as part of the CBR programme. As a result, a one week workshop was held for 32 teachers in one Rupununi region.  All the practical arrangements were undertaken by the teachers themselves. An outcome of this initial workshop was collaboration with the Ministry of Education  to run a series of these workshops, over a two year period, for all the teachers in the region. A series of specially commissioned reading books has been developed by the CBR team to meet this request. The Guyanese Ministry of Education subsequently invested US$50,000 in the production of these literacy materials for use in other parts of the country. As a result of the literacy project, libraries have been established in 24 of the villages.
	Partnerships have also been formed with other groups. The Social Impact Amelioration Project (SIMAP) is a body established to offset some of the hardships of the Structural Adjustment Programme which is now in place in the country. The bulk of their activities are focused on the coast. However SIMAP officials invited the CBR project to be the catalysts and intermediaries for their programme in this region. As a result visits were made to six villages to meet with the community to learn of their needs and to formulate proposals to fund these needs. Projects have now been completed in three of the villages to improve the water supply and upgrade the local health centres.  The CBR team's role has been in helping in the formulation of the proposals, networking with the funders and monitoring the implementation of the project.
	The 'Hopeful Steps ' programme in the Rupununi began three years ago with very modest goals. The vision has however widened over this period.  The seeds are planted for an integrated model of development in this region.  This direction has emerged out of on-going consultations with the local communities. The various innovations were not designed from the capital city but arose out of an attempt to respond to the expressed needs of the community.  
	The CBR team felt that one contribution they could make to the region was to help document the culture of the people. A number of attempts have been made to achieve this goal.  This has included the production of a video and audio cassette of the indigenous music of the region; a story book - written in the local languages - promoting awareness of the needs of disabled children within the folk lore of the people of the region; as well as a video and educational training materials on the rainforest to help the children living on the coast of Guyana  appreciate the majesty and potential of this region of their country.  Another input has been a  series of story books on appreciating water as a resource. 
	When the programme began three years ago we were informed that there were no disabled persons in the region.  We knew this was  not the case but to have argued the fact would have been futile.  Instead we began by building  an approach to training that would contribute to the development of all of the children in the Rupununi.  However having gained the trust of the people, the focus has now widened to encompass the needs of the disabled persons.  A comprehensive survey of disabled persons of the entire region has been completed recently and a Plan of Action to respond to the needs of those identified by the survey is now emerging.  Had we adopted a narrow disability focus from the inception the CBR programme would have been dismissed as an irrelevance within the region. 
	The Rupununi, the most isolated and remote of the regions in which the CBR programme is operating, is therefore proving to be a stimulating environment in which to increase our understanding of the role CBR initiatives may play in the development of communities.

Creation of Regional CBR Committees 
As the 'Hopeful Steps' programme expands we are mindful of the need to balance expansion and consolidation. Within each of the regions in which the programme operates a Regional CBR Committee has now been established.  A series of meetings were held throughout the various regional programmes to write a constitution for the Committees.  The Regional Committees are assuming more and more of the management functions of the programme and are helping to ensure the maintenance and continuity of the programme. 
	We began to appreciate that many of the social and emotional needs of parents could be most effectively met by participation in an informal voluntary association with other parents. The Committees provide  a network of families who offer mutual support and who are beginning to assume an advocacy role.   The Committee structure has evolved out of the project and was not preconceived from the beginning as the way to manage the innovation. 

Regional Resource Units
A key element of the 'Hopeful Steps' programme has been the development of community based resource centres run by the Regional CBR Committees and which provide a valuable training  base for both parents and professionals.  Seven of these centres have now been established in the country. They provide a link between the community worker and the professionals and between the disciplines of health and education. The sustainability and technical quality of the innovation may well depend on this intermediate link. 

Development of Training Materials
As the programme evolved we felt the need for locally produced video- training materials that would reflect our own particular needs and culture. Dr. Roy McConkey played a key role in the development of the training materials, produced and developed in Guyana.  The materials were originally intended for use within Guyana.  However we have now received requests from CBR programmes in 44 countries for copies of the materials which have been translated into Arabic, Spanish and Portuguese.  This, in itself, has been  a powerful motivating force for the families that we work with as they see the growing international interest in the approach they have helped to develop.  The materials have been created by a team of persons to produce a collaborative effort. 
	One example of the training materials is the production of a video-training package on puppet making. Puppet Making workshops have now been held throughout the country. In turn, the CBR workers have presented over 40 shows in schools, cinemas, and public halls to a total of over 10,000 persons as one contribution towards improving attitudes within the community to persons with disabilities. A video of their efforts was featured on national television as a result of sponsorship from a variety of local community businesses. 
	The word 'empowerment' is common in the literature on development, often however  the term is more spoken about than demonstrated. The production of the training materials has provided an avenue of service for people from very varied backgrounds and has offered a tangible means for demonstrating community action in the area of rehabilitation.

Promotion of Community Awareness 
From the beginning, time was invested in promoting local awareness of the programme. Extensive coverage in the newspapers, radio and local television did much to enhance the prestige of the CBR initiative and nurture the involvement of the community in the programme.  This process of keeping the community informed of the developments within the project was nurtured through the publication of a quarterly CBR Newsletter which is distributed to over 500 persons throughout the country.

Wider role for CBR Co-ordinators
The term 'community involvement' is repeatedly extolled in the literature and yet few effective examples are readily available of how it translates into practice.  Many of us working in the field of CBR may be qualified in technical skills, however we are often naive in terms of social, political and organisational skills.  We need to develop a wider role, helping the community examine their own problems and letting them realise they have within themselves the capacity to meet many of their needs.
	Adequate and appropriate training is a crucial first step to be provided for the CBR workers. However, support and supervision are equally essential.  It is clear that  a key to improved services depends on a more innovative approach to manpower utilisation and preparation.  Within the programme we have endeavoured to provide a supportive model of supervision where the goal of the support is to promote the confidence of the CBR worker and develop the respect of the family for them.  The role of the Regional Co-ordinator is to help the volunteers, the disabled persons and the families to identify their own needs and then to assist them in formulating creative responses to the challenges. In response to this nurturing model the self-confidence and self-worth of the participants grew as they realised they could contribute something of value to others. Such people can in turn become agents for change, awakening people to their potential and to their human rights.
	At present the 'Hopeful Steps' programme operates in five of the 10 regions of Guyana.  Plans are now prepared to expand into two more regions over the next two years.  In each of the five regions the CBR programme employs two or three part time 'Regional CBR Co-ordinators' who live within that region.  In addition we are fortunate to have three full time Voluntary Service Overseas (VSO) volunteers from the United Kingdom.  In all cases, the Regional Co-ordinators are part-time, paid staff. 
	The Regional Co-ordinators have been drawn from a very diverse range of backgrounds. In most of the rural areas in Guyana there is no one available with a rehabilitation/disability training.  Of the 13 co-ordinators listed below, 10 have received their training as part of the CBR programme. 

	 Parents of disabled children (2)
	 Head of Nursery School (2)
	 Nurse (2)
	 Education administrator (2)
	 Physiotherapist (1)
	 Teacher of the hearing impaired (1)
	 Health Visitor (1)
	 Occupational Therapist (1)
	 University lecturer (1)

Working within an Existing Infrastructure
The early years of the programme relied solely on volunteer manpower from the rural communities. Their original 120 hour training programme grew to over 150 hours as they requested additional elements to enhance their repertoire of skills. A major challenge however emerged in terms of how to incorporate CBR into the existing government infrastructure in order to expand coverage in an economically viable manner.   
	Of the original 96 volunteers who were trained in three Regions - Berbice, ECD and Essequibo Coast - 73 opted to  undertake an extra 20 hour module to prepare them for the role of 'trainers' of others. Following this additional training the 'volunteers' formed themselves into teams of 4 or 5 and then offered a series of 10 hour modules on CBR for teachers, parents and health workers in their regions. Initially the plan was that the CBR 'supervisors' would take charge of these 10 hour modules and the volunteer teams would be used as resource persons to supplement the inputs of the more experienced trainers. However it soon became apparent that the teams have invested considerable time and resources in this process and that they were quite capable of presenting the 10 hour modules on their own. Over 160 teachers have now completed the 10 hour course developed by the CBR volunteers.
	The  CBR co-ordinators prepared a training manual for these 10 hour modules. The manual offered a very detailed overview of each of the sessions.  The newly formed teams began by using the guides as a virtual script for the sessions but as their confidence grew they introduced other material into the training.
	The time which has been invested in the development of training materials and human resources is now beginning to pay dividends. Two new, University accredited, CBR training courses are now taking place in ECD and Berbice Regions.  Each course is for 120 hours. The courses are managed and presented by resource persons who have been raised up through the early years of the CBR  programme. The National CBR co-ordinators play no more than a monitoring role in these courses. The various training materials that have been produced on the programme form the nucleus of the course.
	These developments in the field of the 'Training of Trainers' has been most significant as it offers pointers towards how the programme can become sustainable.  It has provided a key path of service for volunteers who have remained loyal to the programme far beyond their initial commitment as volunteers for 2 years. 
	The CBR programme in the Rupununi is now being expanded by each of the 33 CBR teams presenting workshops for community leaders and parents in their own village on early stimulation and the making of toys. 
	In collaboration with the Ministry of Education  another element of the  CBR programme was developed to train Nursery School teachers within the Essequibo Coast region.  A series of discussions was held with ministry officials and with the teachers of the region.  In the Essequibo Nursery programme all 30 teachers have played a meaningful role in the project.  They have now developed four regional Resource Units to begin to cater for some of the needs of the children with disabilities in this relatively isolated region of the country.  The Resource Units operate out of the Nursery schools on a weekly basis and provide a meeting ground for parents of disabled children.

	Insert Photo 7.2 here

A programme that therefore began on a modest scale with volunteers is now expanding and beginning to forge links with the wider community.

Involvement of Disabled People
The CBR programme in Guyana has focused on the needs of children over the past nine years.  In accordance with the written constitution, more than half the members of each of the four  Regional Committees are parents, family members of disabled children or people with disabilities. 
	A number of the children who entered the programme some years ago are now young adults and recently the focus of the programme has widened to embrace the needs of adults.  Whilst the programme has had considerable involvement on the part of parents and family members of disabled children, the involvement of adult persons with disabilities has been far more limited.  This highly significant imbalance is now a major focus of the next phase of development of the 'Hopeful Steps' programme. Already each of the Regional CBR Committees has this challenge as a major focus on their agenda. 
	Our funders, AIFO, are sending Mr Tambo Cammara, from Mauritania, one of the international leaders of the disability movement, to Guyana to help to stimulate that process. The lack of involvement of disabled persons in the 'Hopeful Steps' programme is a reflection of the very low profile played to date, by the disability movement in Guyana.  

Lessons Learnt
Few CBR programmes have moved beyond small scale projects to large scale innovations.  As yet few governments have made any significant commitments and investments to establish national CBR services.  Most CBR programmes are regarded as 'additional programmes'.  Moreover the attempts that have been made to work within existing infrastructures have often become little more than a minor facet of an existing service provision to which no particular priority is given.
	CBR offers to policy makers, professionals, planners and community leaders and to persons with disabilities themselves, a new approach to rehabilitation.   Our programme has travelled a far way from its uncertain beginnings almost a decade ago.  Aspects of the programme are presently being evaluated by independent evaluators.  Two student researchers are presently in Guyana for six months from the University of Amsterdam and a Masters student from the University of California at Berkeley is carrying out her dissertation on the CBR work in the Rupununi.  Within the year, two documents will be available that are the products of extensive, independent evaluations by researchers from prominent research institutions.
	For our own part, we believe five main lessons have been learnt as we reflect on the past ten years work in the area of mobilising communities.  They can be summarised as follows.

1. A profound faith and respect for the rural people
The goal of the project has always been to help the rural people to bring about change in their own condition and, in the process to take more responsibility for their own affairs.  
	A significant element of the 'Hopeful Steps' programme has been focused on raising up human resources from one region to introduce the CBR programme into other areas.  Those involved in this process have never been used in this role before.  The term 'empowerment' is now replete in every article on development.  The CBR workers in the Guyana programme may not know the term 'empowerment', but they feel a sense of pride that they are now pioneering the CBR programmes to others in new regions.  
	The goal throughout the project has been to reinforce and nurture, rather than supplant, the authority of the teachers, health workers and community leaders in the regions.  Education and training of local personnel are at the core of the project rather than the provision of services by external agents.  
	Efforts have been invested in helping each person realise the role they can play in the development of their community.  For many persons the prevailing attitude at the beginning of the project was that the rural people of Guyana were poor, passive recipients of what others would donate to them.  The change in attitude is reflected in the comments made by one of the health workers to an  independent evaluator (Saha, 1995):

		We have been encouraged to do something...to help ourselves....this is a self-help programme....we have learnt that we can do something...it is very encouraging.

The philosophy which has permeated this project calls each individual to play a more active role in their own development and to inspire people to realise that they can indeed play a key part.  Integral in this process has been an appreciation of the profound spirituality of the people of Guyana.  For many of the people involved in the project the activities were a tangible way in which they could put into action their desire to be of service to others.    

2. Promoting sustainability by avoiding dependency
In facilitating the sustainability of the intervention the local communities have been encouraged to take as much responsibility for the project as possible.  The work of the  Village Health Assemblies (VHAs) throughout the Rupununi and the Regional CBR Committees on the coast have provided the medium through which to involve the community at all phases of the project.  The  VHAs and Regional Committees have a clearly understood decision-making role and members feel a sense of real responsibility for the programme which they are increasingly regarding as their own.  Both groupings are providing a definite channel to facilitate the consultative process within the rural communities.
	The goal of sustainability is the touchstone of all development interventions.  Only time will tell whether this project will be sustainable beyond the inputs of external interventions.  The emergence and growing maturity of the VHAs and the Regional Committees, along with the high emphasis given to the training of these bodies in the skills of consultation, leadership skills, problem solving and decision-making, has established a very promising basis for long term development. 
	Some other features of the project which have promoted sustainability include:

	 the clear match between regional needs and programme objectives;
	 the use of the existing health and education infrastructure rather than creating new cadres of workers;
	 the management of the programme is based within the rural regions;
	 the focus is on involving and empowering communities.

A strong base has therefore been established on which to build for longer term sustainability.   

 3.  Development needs to be in harmony with the local culture
The 'Hopeful Steps' programme is guided by respect for the culture of the regions  and tries to proceed in harmony with it.  Considerable time was expended at the outset of the project to meet people throughout the regions to learn about the needs of the areas.  For example in the Rupununi, one of the major activities of the first year of the project was to produce, in consultation with the teachers and health workers, a set of training materials on child development and early stimulation  which reflected the practices of the native peoples of the region. These ideas were then produced in the form of a series of video programmes and an illustrated teaching manual called 'A New Tomorrow' which has now been used throughout the region and with native peoples in a number of other countries in Central and South America.  

	Insert Photo 7.3 here

Project staff have also helped local people to record the music and oral traditions in their region and to write story books in local languages.  Festivals of local poetry and song have been held and a children's newspaper started, all of which have illustrated  the rich cultural heritage of the people of Guyana.  
	Examples of 'harmonious development' are not always easy to document.  However the desire of many persons in the region to see the programme expand suggests that it is evolving in a way which is respectful to the people and their administration.  A further illustration of this principle was gaining the consent of local officials at each stage of the programme intervention.

 4. The promotion of unity
A guiding principle for the project was to promote the unity of the community.  The programme has been effective in establishing partnerships, both within the Rupununi region and on the coast, with services and departments which normally work separately. The bringing together of these pre-existing resources also promotes the sustainability of the intervention.  The support of the government's efforts in the area of health and education is a reflection of the desire to promote sustainability rather than attempting to develop alternative structures.  It is not unusual for NGOs to supplant and disempower the existing government system.   By contrast this programme endeavoured to support the government workers who work at the base of the health and education systems within the various regions.

5. The key of consultation
A guiding principle of the project was that it should be founded upon open and equitable consultation.  The programme facilitated the coming together of people from diverse backgrounds and perspectives to a common forum to discuss their needs and concerns.  They were given access to the decision-making process at every level of the intervention.  
	A key element in this process was for us to be able to listen carefully and then act on what was heard.  There was no script in hand at the outset of the project.  The actions of the project emerged out of the dynamic consultative process.  For example, during the exploratory visits in the Rupununi and at the needs assessment exercise at the first series of workshops in each sub-region, the goal was to try and appreciate the needs of the area.  In adopting this approach we were fortunate that our funders, AIFO and the EC, realised that such a process takes time and cannot be hurried.  
	The programme that was subsequently developed was therefore characterised by flexibility and responsiveness to suggestions from within the region.  This process was further facilitated by a deep sense of respect on the part of the programme initiators for the people of the region.  The process of consultation proved to be the major key at each of the subsequent workshops where the facilitators constantly adopted a reflective process in analysing progress to date.

Will the Model Work Elsewhere?
Can the model of mobilising communities  outlined here be duplicated elsewhere under similar conditions?  It is our belief that the model is replicable given certain conditions:

	 the promoters of the innovation have a belief in the potential of the people they are serving.
	 the innovators have the ability to guide individuals, who for so long have been traditionally led by others to take charge of their own affairs.
	 the active participation of the recipients of development is achieved at all phases of the development process.
	 the community has a desire for change.
	 the developers and implementers of the programme are willing and capable to listen to people who may not be articulate.
	 the innovators are experienced in the art of consultation.
	 the funders allow the implementers sufficient time throughout the programme to facilitate the consultative process.
	 partnerships are effectively established between all the key players and the major government agencies.

The 'Hopeful Steps' programme has attempted to develop a management style which would allow the lofty concepts of 'community participation' and 'empowerment' to be nurtured.  There was no predetermined script for the project, many of the most creative features of the programme emerged from the participants over the course of time.  From a modest beginning in one region of the country, the Hopeful Steps CBR programme has now emerged into a wider integrated development project involving several thousand people.

Acknowledgements

	We gratefully acknowledge the funders of this project; the European Community and  Amici di Raoul Follereau. Additional financial assistance has been provided by  the Canadian International Development Agency and UNICEF.  The project is co-ordinated by Dr. Brian O'Toole and Ms Geraldine Maison-Halls.  The training in Guyana is facilitated by the Institute of Adult and Continuing Education of the University of Guyana.  The photographs are by the author.

Brian O'Toole is a British educational psychologist who has worked in Guyana for 17 years.  Initially he spent six years introducing and developing the Special Education programme at the University of Guyana and for the past nine years he has directed the Guyana Community Based Rehabilitation Programme.  He has worked as a consultant in rehabilitation for PAHO-WHO, UNESCO, UNICEF and Save the Children UK and Norway.

Contact Address
	Guyana CBR Programme, 
	c/o European Commission
	PO Box 10847, 
	Georgetown, Guyana