The above notwithstanding, disability has remained a complex phenomenon. This complexity has been documented well (Barton 1992; Powell 2003) and the debates surrounding its culturally variable and highly contested nature have been appreciated (Devlieger, Rush & Pfeiffer 2003). Throughout the years, the conceptualisation of disability has been held together by the ‘passion for sameness’ at the expense of ‘love for difference’ (Stiker 1999). According to Stiker (1999:ix), a ‘passion for sameness’ has occasioned the segregation and marginalisation of people with disabilities and their exclusion from mainstream society.

This marginalisation has been patent in how various institutions of state, particularly in developing countries, have handled the issues of disability and people with disabilities. The present article acknowledges that people with disabilities in Lesotho have for years, since the foundation of Disability People’s Organisations (DPOs), demanded a fair share in the opportunities that are afforded every citizen. But this demand has been met with a litany of broken promises which at the same time continued to construct people with disabilities as add-ons who can only be assisted when everybody else have been assisted. These constructions have influenced people’s perceptions about disability and people with disabilities and continue to do so. The policies that are formulated and their implementation are foregrounded in the perceptions that are informed by people’s constructions about disability and people with disabilities.

However, there are positive indications that point to a switch to improving the lot of people with disabilities. Firstly, the draft National Disability and Rehabilitation Policy of 2008 was made policy in 2011. Secondly, the establishment of the new Ministry of Social Development is a positive development and a realisation of an idea that was conceived in an effort to improve on the output of the Department of Social Welfare. The National Disability and Rehabilitation Policy 2011 (NDRP) read together with the Draft Disability and Rehabilitation Policy 2008 (DNDRP) constitute the foci of the analysis below.

The adoption of a social model marks an important theoretical and practical shift from the individualistic medical model (old paradigm) with its emphasis on diagnosis and treatment or elimination of a condition (Gathiram 2008). Instead it embraces a view that disability is a natural and normal part of human experience that in no way diminishes a person’s right to participate fully in all aspects of life (MOHSW 2008, 2011). It works towards the elimination of the environmental, institutional, attitudinal and economic barriers that prevent people with disabilities from participating meaningfully in society (MOHSW 2011). Situating the policy formulation within the framework of the social model will also curb the temptation, inherent in the location of the DPOs within the MOHSW, to view disability as an exclusive preserve of the medical and welfare professions.

The policy states clearly that disability is a human rights and developmental issue, a view that lends itself to sustainable and people-centred development (Gathiram 2008). To buttress mechanisms for achieving objectives of this developmental approach, the Community-Based Rehabilitation (CBR) strategy has been adopted, with the potential, if followed through well, to yield good results in the rehabilitation, equalisation of opportunities and social integration of people with disabilities (Gathiram 2008). Its community-based, participatory and action-oriented nature has made it better placed to enhance ownership, agency and accountability of programmes geared towards the integration of people with disabilities into society.

Mendis, Kachingwe and Khabele (2009:2) suggest, regarding Lesotho, that with cooperation and partnership it could move towards a coherent rights-based framework, with the MOHSW in a management role, the Lesotho National Federation of the Disabled (LNFOD) in advocacy and monitoring roles and local government structures in implementation roles. Such cooperation and clarification of roles would also help to stem the duplication of efforts that threatens to derail the social integration of people with disabilities (Mendis et al. 2009). It is the author’s opinion that even with this division of roles, people with disabilities have to participate at all levels, or at least be consulted at every stage. It would make absolutely no sense for management to conceive of ideas that are not informed by a lived experienced of people with disabilities only to be brought down to DPOs for approval, implementation and monitoring. This would undermine the spirit and principle of self-representation by people with disabilities that underlies the policy.

Despite the positive developments evident in the tone and orientation of the disability policy, anxieties remain. Gaps and rough edges of a theoretical and practical nature will always be there. These will be elaborated upon in the following sections.

The focus of the social model is to point away from an individual with impairment to the society which disables him or her through limitations imposed by the same society. It targets removal of disabling barriers and advocates equality in opportunities and rights for people with disabilities (Albert 2004). In the concrete the social model advocates for removal of barriers, physical as well as attitudinal. It strives to enhance the educational opportunities of people with disabilities in order to maximise their ability and potential to compete equally with everybody else in the labour market.

On the other hand, welfare agencies were founded on the realisation that citizens do not have equal access to the country’s resources. Others, through no fault of their own, are vulnerable, poor and marginalised and therefore in need of some form of grant. If provision of social grants for individuals with disabilities, and who have been declared so through appropriate assessment procedures, is at the centre of machinations of the welfare state, the question is: how can this stance be reconciled with the social model stance which locates oppression in society and not in the individual? In other words, can the developmental approach, which aims at breaking economic dependency of people with disabilities (Gathiram 2008), be reconciled with a service-based approach, which creates the same dependency it intends to break from? The DNDRP (MOHSW 2008:16) recognises this theoretical quandary:

‘There is a need therefore for Government to provide social protection and disability grant to [people with disabilities] … Changing the way people regard disability from a purely health and welfare issue to a primarily human rights and development issue has significant implications for the principles, objectives and goals of existing welfare services. It implies that welfare services need to be designed to facilitate independence in society, rather than dependence on welfare services’.

Could this indicate that the policy is tending towards adoption of a model that combines social security with social and community development in line with international disability policy, where the focus has shifted from guaranteed income security towards economic integration (Mont 2004)? It appears that the policy balances theoretical considerations and pragmatic concerns. Within the framework of a social model, in which disability is seen more as a human right and developmental issue than an individual issue (Swartz & Schneider 2006), skills provision and creation of job opportunities are more important than disability grants. For disability activists the catchphrase is ‘human dignity and not separate services’.

Swartz and Schneider (2006:236) concur that the social model is founded on the assumption of a society that is as equal as possible for all. However, given gross poverty, inequality, inequitable distributions of resources, lack of skill development as well as high unemployment rates in Lesotho, application of a social model with a focus on creation of equal opportunities alone becomes a mammoth task. A stark reality to contend with is that people with disabilities invariably bear the brunt of these adverse consequences and would therefore, at some point, need social services in the form of grants.

As noted above, disability is a fluid concept. Its definition is dependent on who is attempting it and for what purpose. The Department of Social Welfare in Lesotho was founded with the purpose of attending to poverty and other social problems. That people with disabilities’ concerns are taken care of within this department suggest that disability is an issue that is in one way or the other associated with poverty or viewed as a social problem. Lesotho is rated among the poorest economies with high rates of unemployment and poverty, as well as differential access to resources (May et al. 2002). Although these needs are of a general nature, affecting the whole society, people with disabilities feel most the effects of poverty and marginal opportunities in the labour market.

Under these circumstances, their reasonable option is to wait for disability grants, but this is not as simple as identifying oneself as such and then receiving it. Rather, it involves a normal welfare process of diagnosis, normally referred to as ‘assessment’, which seeks to answer the question whether an individual qualifies to be categorised as disabled, and therefore deserving of a welfare benefit or disability grant (Swartz & Schneider 2006). Looked at very closely, the diagnostic assessment goes beyond serving only as a mechanism that helps administrators to distinguish ability from disability.

However, the assessment cannot be made without an assessment tool, otherwise such an assessment would depend on the whims of the person in office. Developing such a tool raises questions: Would the development of such a tool depend on the state of being of a person with disability or on the complex and changing environment (Swartz & Schneider 2006)? Who would have the last word on the development of such a tool and the criteria adopted in administratively identifying a person as disabled and therefore deserving of a disability grant? Whose needs are met by the development of such an assessment tool: the welfare authorities or people with disabilities?

The assessment tools are developed to ascertain the correctness of the decisions made about the welfare systems’ classification of ability and disability, so their purpose is to describe and classify. Assessment is also about constructing that which is described and classified, but classification also leads to apprehensions about who qualifies and who does not. Perhaps even more sensitive is the issue of who has the final say on who qualifies for a grant and who does not, on the basis of which norm is applied (Soudien & Baxen 2006). This sensitivity has to be understood in the light of the sentiment expressed by many people with disabilities and DPOs that projects are often written in their name but they are the last to enjoy the benefits. This sentiment, whether real or unreal, is an issue of power relations and justice, and calls for the re-examination of the kind of ethics that drive the interaction. It calls for a review of power valences that create the hierarchy between ‘us’ and ‘them’, with the ‘us’ responsible for the setting of norms and standards, and for the administration of disability grants. The ‘them’, meanwhile, can only be thankful or else they are dubbed ‘ungrateful’.

The tendency is nearly always to assume that the needs served are clearly those of people with disabilities, but this is not the case. There are two kinds of need here: those of the welfare authorities and those of people with disabilities. The welfare authority is interested in the proper administration of a welfare benefit, which can only be ascertained through an assessment procedure. A person with disability would like to be acknowledged as such and given his or her due. These needs do not have to clash, but they often do, and the people with disabilities usually benefit the least, if at all.

Through this procedure a person is labelled ‘administratively disabled’, which becomes a need that can be met by a welfare authority. Thomas and Loxley (2001:52) regard this case as one in which a welfare authority, ‘with a stroke of a wand’, is changed from assessor and labeller to benefactor and helper. Not only is there a change of roles but also a play of power valences, the effects of which are ‘hierarchizing, and forever, pushing x above y’ (Thomas & Loxley 2001:84). What Foucault (1991:308) terms a ‘disciplinary regime’ permeates ‘almost seamlessly and unquestionably the day to day workings of institutional life of people with disabilities’.

The NDRP does not yet have an answer to many of the above questions, but anticipates guidelines that would provide for the assessment of those who do and do not qualify for a social security grant.

FIGURE 1: Heavenward stages.

The language of rehabilitation is associated with the medical model of disability, stemming from the hospital (Stiker 1999). The adoption of the rehabilitation language within the NDRP, consciously situated within the social model, the new paradigm, is evidence of this medical shadow and the dominance of the medical model. Despite the intent to shift perspectives and nuances, the link between rehabilitation services and medicine is so glaring that any effort to divorce them becomes a futile exercise. The rehabilitation model as a substitute appellation for the medical model betrays this tendency. The trouble in shifting from one paradigm to the other is evident in this policy, and could create conceptualisation problems that are often part of working with and within models and paradigms. It begs the question as to whether one is working within the ‘new paradigm’ but with nostalgia for the ‘old paradigm’.

The policy defines rehabilitation as a means to help people with disabilities to fully participate as members of society (MOHSW 2008, 2011). One cannot fail to see the common power implications of helper (powerful) and helpee (vulnerable), doctor (powerful) and patient (vulnerable), which have been a subject of intense debate in the field of modern therapy (Van Wyk 2007).

Reading the definition of rehabilitation together with the objectives of rehabilitation as a priority policy area (MOHSW 2011), it becomes clear that the focus of rehabilitation is not society but people with disabilities. The objectives of rehabilitation are stated as promoting availability of the necessary skills and services to all people with disabilities, and enabling them to achieve and maintain their optimum physical, sensory and functional level. Nowhere under the objectives of rehabilitation is mention made of society as the object of the rehabilitation services. It is indisputable, therefore, that rehabilitation services are directed to people with disabilities, and that their accessibility and availability are made possible by the presence of rehabilitation professionals at all levels. McNamee (1996:145) uses the term ‘identity adjustment’ – which is what the medical model seeks to achieve – to refer to the process of rehabilitation.

This use of words evokes the relations of power between the rehabilitation service provider, who is skilled and equipped, and a person with disability, who is portrayed as lacking in something that must be filled by professional medical personnel (Stiker 1999). This does not seem to square up well with the social model of disability.

One of the objectives of rehabilitation as spelled out by the policy is to ‘enable [people with disabilities] to achieve and maintain their optimum physical, sensory, and social functional level’ (MOHSW 2011:6). The word ‘achieve’, used together with ‘optimum’, has a sense of ‘not yet there’. What would be the ‘not yet there’ compared to the present condition? Is it not suggestive of the undesirable state of disability compared to the desirable state of optimum physical, sensory and social functional level? On what basis does one measure that optimum and functional level, and who determines the achievement of that functional level? It evokes memories of the ideal, the normal into which the promise to restore an individual with disabilities comes alive. Is the promise to restore an individual to the ideal not a reassertion of the binaries of abnormal and normal? If answering in the positive, as I think I should, the binary logic harbours workings of power. It is founded on the moral and political hierarchy of the normal over the abnormal. This hierarchy, as Danforth and Rhodes (1997:359) assert, can be seen in the way the abundant social value accorded the first term is negatively mirrored in the corresponding devaluation of the second term.

By embracing this form of a rehabilitation discourse one is not far from the discourses of the late eighteenth and nineteenth centuries, in which restoring disabled people to a level of acceptable functionality was achieved through educational facilities and medical correction and technology (Stiker 1999). The definition of disability in the NDRP only helps to entrench this nostalgia. It further underlines power valences between people with disabilities and rehabilitation professionals through the language used (Stiker 1999).

Rehabilitation represents the medical gaze, as an eye of surveillance with immense power and an exclusive claim to knowledge, watching over and controlling people with disabilities (Foucault 1978). In the view of Oliver (1990), that is not appropriate because disability is not a medical condition but a social state, but I argue that it may not be necessary to pit one against the other in an either/or dichotomy. Read within a postmodern context, disability surpasses the social medical dichotomy and represents a complex and contingent variable that ‘describe[s] different aspects of a single experience’ (Shakespeare & Watson 2002:24). Care has to be taken therefore that the rehabilitation strategy embraced by the NDRP does not become a way of carting off the oppressive conditions of the medical model of disability through the front door only to bring them back through the back door.

However, this is not to suggest that people with disabilities do not have medical needs, but rather that the situation of a rehabilitative language, which insinuates the medical model, within the social model of disability is problematic. At issue here is whether there is a role for rehabilitation language and practice within the social model of disability. If, according to the social model, society has to change and not individuals, why should the language and practice of rehabilitation that target people with disabilities be dominant in a policy that adopts the social model as its guidepost? Perhaps, as Derrida (1976) would have suggested, we should put the word ‘rehabilitation’ under erasure to underline both its necessity and its inadequacy.

The Ministry of Health and Social Welfare, through its National Disability and Rehabilitation Policy 2011, straddles two paradigms, having adopted the social model with its one foot in the deficit and medical model. In the process, people with disabilities are constructed as ambiguous. Within the context of this research there is no intention to pit one model against the other, as both have their usefulness. The above discussion on the discourses within the Ministry of Health and Social Welfare in Lesotho reflects what in liberation theology is termed ‘social analysis’ (Lartey 2003:127). The aim is to explore ways in which power relations within different public institutions in Lesotho hold sway over the human person, particularly one with disability.

The constitution of Lesotho identifies the needs of people with disability as rehabilitation and resettlement (Lesotho Government 1993). It therefore identifies and constructs people with disabilities as ‘abnormal’ and in need of regularisation before they can be accepted into the fold of ‘the normal’. The MOHSW, through its NDRP, embedded in the social model, puts people with disabilities at the mercy of professionals and medical experts. The nature of the language adopted and used without critique, specifically in the NDRP, has further constructed people with disabilities as institutional subjects whose lives depend on the policies, laws and protocols of the powerful.

Through the use of Foucault’s ideas of governmentality and power, this paper has explored how policies and laws connive to create social meanings and power relations through language and models. Foucault’s ideas have served to unwind the structural composition of the Ministry of Health and Social Welfare as a public institution in terms of power relations. Power and knowledge combined in how health and welfare contributed to the construction of ambiguous but objectified disabled identities. Foucault’s ideas have also revealed that disability is sustained by social practices which serve the interest of dominant groups in society (Burr 2003), through constructing people with disabilities into ‘particular and shifting forms of objectification’ (Jolly 2003:517).

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