482 chapter 50
FINANCING
The myth of self-sufficiency
It is a goal of many community programs to become as financially self-sufficient
as possible. Only when a program does not depend on outside funding, can the
community and participants of the program have a full sense that “The program is ours.
We run it. We control it. We make the main decisions ourselves.”
Realistically, however, for health programs in general and for rehabilitation programs
in particular, economic self-sufficiency is difficult to accomplish. This is especially
true if the program aims to serve mainly those who are poorest and whose needs
are greatest. The poor earn barely enough to feed and clothe their children, and then
sometimes not adequately. The additional expenses of trying to meet the needs of a
disabled child may be too much for the poor family to bear, even when the costs are
kept low.
The biggest obstacle to economic self-sufficiency of any
community program is poverty.
In a country where social injustice causes widespread poverty, it is not fair to expect
the poor to pay for more than a small part of the cost of rehabilitation services or aids.
Nor is it fair to ask a busy rehabilitation team to try to make their program self-sufficient
through separate ‘income-producing activities’. (However, ‘income-producing activities’
can help meet some expenses and prepare disabled persons to work and earn
independently. We discuss this on the next page.)
True self-sufficiency of a community service program may only be possible
through a process of social change and fairer distribution within the whole structure
of the society. Only when enough jobs are available and nearly every family earns
enough to be self-sufficient in terms of meeting its basic needs, can program self-
sufficiency become a realistic goal. In the meantime, some sort of outside funding,
government or private, is usually necessary.
Funding —government or non-government?
Ideally, governments should help meet the costs of people-centered community-run
service programs. Unfortunately, government funding often brings with it a high degree
of outside control, including pre-defined (often disabling) limitations regarding local
planning and how much community workers are taught or permitted to do. The disabled
and their families tend to become the objects of program objectives, to be worked upon,
rather than the leaders in their own struggle for dignity and self-reliance.
Also, it is usually difficult for a local village or community group to ask for and obtain
funding from the government. The red tape, ‘preliminary investigations’, restrictions, and
delays are often endless. More promises are made than are kept. Thus to speak of a
government-financed community-oriented program usually makes little sense.*
*One exception to this is the ORD (Organization of Disabled Revolutionaries) in Nicaragua, a non-government,
people-centered program for which the Sandinista government had set up a red-tape-free ‘auxiliary fund’
to help poor families meet costs (see next page). Such restriction-free aid may only be possible in countries
where popular governments have a strong political will to serve the people fairly.
Disabled village Children