Community Based Rehabilitation

COMMUNITY BASED REHABILITATION

Presented By-Ms. Papri Das

Assistant ProfessorPeerless College of Nursing

The emergence of the concept ofThe emergence of the concept ofCommunity Based RehabilitationCommunity Based Rehabilitation

“If you give a person a fish, he’ll eat for a day;

if you teach him to fish,

he’ll eat for a lifetime.”

The emergence of the concept ofThe emergence of the concept ofCommunity Based RehabilitationCommunity Based Rehabilitation

“If you give a person a fish, he’ll eat for a day;

if you teach him to fish,he’ll eat for a lifetime.”

Community Based Rehabilitation (CBR)

brings rehabilitation know-how to villages

and urban slums, and CBR personnel facilitate people to take

responsibility for their own lives!

WHATWHAT IS CBR? IS CBR?

CBR CBR is is a a systematizedsystematized approach approach

withinwithin general community developmentgeneral community development

whereby whereby Persons with DisabilitiesPersons with Disabilities are are enabled enabled

to to livelive a a fulfilling lifefulfilling life

within their within their own communityown community, ,

making maximum use of making maximum use of local resourceslocal resources

and helping the and helping the community becomecommunity become awareaware of it’s responsibility in ensuring the of it’s responsibility in ensuring the

inclusion and inclusion and equalequal participation of PWDs. participation of PWDs.

In the process,In the process, PWDs PWDs are are also madealso made awareaware of their own role and responsibility, as they of their own role and responsibility, as they

are part of the community.are part of the community.

Definition of CBRDefinition of CBR

““a strategy within general community a strategy within general community

development for thedevelopment for the rehabilitation, rehabilitation,

equalization of opportunities and social equalization of opportunities and social

inclusion ofinclusion of all people with all people with

disabilities.disabilities.””

CBR is CBR is implementedimplemented through the combined through the combined

efforts of PWDs themselves, their families, efforts of PWDs themselves, their families,

organizations and communities, and the organizations and communities, and the

relevant governmental and non-governmental relevant governmental and non-governmental

health, education, vocational, social and other health, education, vocational, social and other

services.services.

Side stream

Your BoatMainstream

What if you are in the Mainstream?

What if you are in the Side stream?

Mainstreaming and inclusionMainstreaming and inclusion

Mainstreaming and inclusion is seen as an Mainstreaming and inclusion is seen as an effective way:effective way:(a) to include persons with disability (a) to include persons with disability (b) to give equal opportunities and (b) to give equal opportunities and (c) to provide a non-discriminative (c) to provide a non-discriminative environment for their growth and environment for their growth and development.development.

Major ObjectivesMajor ObjectivesTo ensure that PWDs are able to maximize their physical To ensure that PWDs are able to maximize their physical

and mental abilities, and mental abilities,

to access regular services and opportunities, and to to access regular services and opportunities, and to become active contributors to the community and become active contributors to the community and society at large.society at large.

To activate communities to promote and protect the To activate communities to promote and protect the human rights of PWDs through changes within the human rights of PWDs through changes within the community, for example, by removing barriers to community, for example, by removing barriers to participation.participation.

Evolution of Evolution of Concepts in CBRConcepts in CBR

Disability and RehabilitationDisability and Rehabilitation

Disability is no longer viewed as merely the result of impairment.

The social model of disability has increased the awareness that environmental barriers (attitudinal, physical and institutional) to participation impede the functioning of PWDs as equals.


Disability and RehabilitationDisability and Rehabilitation

Professionals (medical and other) who provide rehabilitation services have the responsibility to provide relevant information to PWDs / their families so that they can make informed decisions to enable them to lead a fulfilling life.


Human RightsHuman Rights

CBR promotes the rights of PWDs to live as equal citizens within the community, to enjoy health and well being, to participate fully in educational, social, cultural, religious, economic and political activities.


PovertyPoverty

There is a strong correlation between disability and poverty.

Poverty leads to increased disability, and disability in turn leads to increased poverty.


PovertyPoverty

In 2000, the UN Member States adopted the Millennium Declaration and set eight Millennium Development Goals (MDGs) to guide the implementation of the Declaration. All the goals are relevant to disability and three goals are of particular concern to PWDs and their families:

Eradicate severe poverty and hunger.

Promote gender equality and empower women.

None of these goals can be effectively achieved

without the inclusion of PWDs

Reduce mortality and Morbidity

BASIC PRINCIPLES OF BASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME

The principles are overlapping, complimentary and inter-dependent – they cannot be separated one from the other.

Source: World Health Organization: Meeting Report on the development of guidelines for Community Based Rehabilitation (CBR) programmes : (1 st and 2 nd November 2004, Geneva, Switzerland)

HOW


InclusionInclusion

Inclusion means the removal of all kinds of barriers which block PWDs from access to the mainstream.

Inclusion means placing disability issues and PWDs in the mainstream of activities, rather than as an after-thought.

Inclusion means including all forms of impairment.


InclusionInclusion

Inclusion also means ‘convergence’ – that is, the involvement of PWDs in the campaigns, struggles and activities of other oppressed groups which are not centred exclusively on disability issues, such as children living on the streets, farmers, land rights and environment, women’s groups.


ParticipationParticipation

Participation means the involvement of PWDs as active contributors to the CBR programme from policy making to implementation and evaluation, for the simple reason that they know best what they need.


ParticipationParticipation

Participation also means PWDs being a critical resource within any CBR programme – providing training, making decisions etc.

It covers the participation of women in all processes and decision-making, and that of other groups who are typically not listened to or excluded.


SustainabilitySustainability

The benefits of the programme must be lasting.

The activity initiated through the CBR programme must be sustainable beyond the immediate life of the programme itself – able to continue beyond the initial intervention and thrive independently of the initiating agency.


SustainabilitySustainability

Strong links between GOs, NGOs, CBOs and DPOs will contribute towards sustainability.

This means that DPOs and SHGs are the hub of any CBR activity.


EmpowermentEmpowerment

Empowerment means that local people, and specifically PWDs and their families, make the programme decisions and control the resources.

It means PWDs taking leadership roles within programmes.


EmpowermentEmpowerment

The empowerment of women is central to any programme.

Empowerment necessitates capacity building – that is, the developing and using of the skills necessary to act with authority and responsibility, independent of the initiating agencies and CBR programme managers.


AdvocacyAdvocacy

Advocacy means the central and consistent involvement of PWDs and their families defining for themselves the goals and processes for poverty alleviation.


AdvocacyAdvocacy

Advocacy is a collective notion not an individualistic one. It means self- determination.

It means mobilizing, organizing, representing, creating space for interaction and demands.

ESSENTIAL COMPONENTS OF ESSENTIAL COMPONENTS OF A CBR PROGRAMMEA CBR PROGRAMME

1. Cover all types of PWDs who need rehabilitation services.

2. Part of mainstream development and have a multi-sectoral approach : including social integration interventions, health, education and economic programmes.

3. The programme should have access to or generate a good and effective referral system.

4.4. The programme should aim at The programme should aim at full full integration of the PWD integration of the PWD into his / her into his / her community.community.

5.5. The programme should have The programme should have gender and gender and disability focus and balancedisability focus and balance..

6.6. The programme needs to have The programme needs to have committed committed and well trained community members and well trained community members as service providersas service providers..

5.5. The programme should The programme should strike a balance strike a balance between provision of service delivery and between provision of service delivery and empowering the PWD, family and community empowering the PWD, family and community through regular transfer of skills.through regular transfer of skills.

6.6. The programme should The programme should facilitate the formation facilitate the formation and strengthening of the disabled people’s and strengthening of the disabled people’s movement to ensure that the rights of the movement to ensure that the rights of the PWDs are not denied PWDs are not denied through advocacy at through advocacy at local, state and national level.local, state and national level.

COMMUNITY BASED REHABILITATION

PRINCIPLES: PARTICIPATION ~ INCLUSION ~ SUSTAINIBILITY ~ SELF ADVOCACY

HEALTH

PROMOTIVE

PREVENTIVE

CURATIVE

REHABILITATIVE

EDUCATION

EARLY CHILDHOOD

DEVELOPMENT

NON-FORMAL

FORMAL SCHOOL

HIGHER

LIVELIHOODS

SKILLSDEVELOPMENT

INCOME GENERATING ACTIVITIES

ACCESS TO FINANCIAL SERVICES

OPEN EMPLOYMENT

EMPOWERMENT

SELF-HELP GROUPS

DISABLED PEOPLE'S

ORGANIZATION

SOCIALMOBILISATION

POLITICAL EMPOWERMENT

SOCIAL

LEGALPROTECTION

CULTURE &RELIGION

SPORTS &LEISURE

RELATIONSHIPMARRIAGE &

FAMILY

ASSISTIVEDEVICES SPECIAL/

TRANSITORY

ECONOMIC CONTRIBUTION &

SOCIAL PROTECTIONLANGUAGE &

COMMUNICATIONPERSONAL

ASSISTANCE

GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~ GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~ POVERTY ALLEVIATIONPOVERTY ALLEVIATION

WHO MATRIX

Multi-sectoral Support for CBRMulti-sectoral Support for CBR

Support from the Social SectorSupport from the Social Sector::

Examples: dExamples: disability pensions, technical isability pensions, technical aids and adaptations, vocational training aids and adaptations, vocational training and employment, and co-ordination of and employment, and co-ordination of referrals for individuals who require referrals for individuals who require services from other sectorsservices from other sectors


Support from NGOsSupport from NGOs and and the local communitythe local community::

Most communities have a variety of Most communities have a variety of non-governmental organizations non-governmental organizations (NGOs) and groups that can (NGOs) and groups that can contribute to a CBR contribute to a CBR programme.programme.

Multi-sectoral Support for CBRMulti-sectoral Support for CBR Support from the Support from the HealthHealth Sector Sector::

The Declaration of Alma Ata (1978) states The Declaration of Alma Ata (1978) states that Primary Health Care (PHC) is the key that Primary Health Care (PHC) is the key to attaining health for all. It also states to attaining health for all. It also states that the PHC needs to address the main that the PHC needs to address the main health problems in the community, health problems in the community, providing promotive, preventive, curative providing promotive, preventive, curative and rehabilitative services.and rehabilitative services.

Multi-sectoral Support for CBRMulti-sectoral Support for CBR Support from the Support from the HealthHealth Sector Sector::

PHC can play a major role in this context PHC can play a major role in this context both as a provider and supporter:both as a provider and supporter:

Early identification of impairments and Early identification of impairments and providing basic interventions.providing basic interventions.

Referrals to specialized services such as Referrals to specialized services such as physical, occupational and speech physical, occupational and speech therapies; prosthetics and therapies; prosthetics and orthotics; and orthotics; and corrective surgeries.corrective surgeries.

Multi-sectoral Support for CBRMulti-sectoral Support for CBR Support from the Support from the Educational Educational SectorSector::

Adapting the content of the curriculum Adapting the content of the curriculum and methods of teaching. and methods of teaching.

Ensuring that classrooms, facilities and Ensuring that classrooms, facilities and educational materials educational materials are accessible. are accessible.

Children with multiple or severe Children with multiple or severe disabilities disabilities may access education through may access education through the use of innovative methods best suited the use of innovative methods best suited to their context.to their context.


Support from Support from the Employment the Employment and Labour and Labour SectorSector::

Collaboration with the employment and Collaboration with the employment and labour sectors. Productive and decent labour sectors. Productive and decent work in a conducive environment work in a conducive environment

Equal employment Equal employment opportunities through opportunities through national policies and legislation; national policies and legislation;


Support from the Media Support from the Media :: All CBR stakeholders should work All CBR stakeholders should work

closely with the closely with the media to identify media to identify

priorities and to provide relevant priorities and to provide relevant

information.information.

MOVING TOWARDS MOVING TOWARDS AN EFFECTIVE CBR PROGRAMMEAN EFFECTIVE CBR PROGRAMME

The following aspects of CBR need to be strengthened to make programmes more effective:

1. Community Involvement and Ownership

2. Multi-sectoral collaboration in CBR programmes

3. Involvement of DPOs in CBR programmes

4. Scaling up CBR programmes

5. CBR programmes to be used as an effective tool for poverty reduction

6. Evidenced based practice

Who Initiates CBR ?Who Initiates CBR ? Community action for CBR is often initiated Community action for CBR is often initiated

by a by a stimulus from outside the communitystimulus from outside the community, , most likely ministries or NGOs. most likely ministries or NGOs.

It is the It is the communitycommunity which decides whether which decides whether CBR will become part of its ongoing CBR will become part of its ongoing community development activities.community development activities.

COMPONENTS NEEDED COMPONENTS NEEDED TO BEGIN A PROGRAMME FOR TO BEGIN A PROGRAMME FOR THE REHABILITATION OF PWDsTHE REHABILITATION OF PWDs

Look out for….

1. An action area where the need is apparent.

2. A community which is receptive.

3. A resourceful and creative outside agency.

4. Persons with Disabilities who need the services of

external agency , community for mainstreaming themselves, to set themselves up as contributors and not just recipients of service.

Steps of CBRSteps of CBR1.1. Identification of person requiring Identification of person requiring

rehabilitation services.rehabilitation services.2.2. Assessment of disabilities and various Assessment of disabilities and various

needs for rehabilitation of identified needs for rehabilitation of identified person.person.

3.3. Provide the basic services through PHC, Provide the basic services through PHC, such as drugs, dressing, materials, such as drugs, dressing, materials, protective foot wear, counseling and protective foot wear, counseling and training in self care.training in self care.

4.4. Introduce / escort the person to village Introduce / escort the person to village health committee along with his/her health committee along with his/her problems.problems.

5.5. Refer to secondary/ tertiary care centers Refer to secondary/ tertiary care centers 6.6. Facilitating the accessibility to socio-Facilitating the accessibility to socio-

economic rehabilitation services.economic rehabilitation services.7.7. Review meetings by all stake holders, to Review meetings by all stake holders, to

discuss progress.discuss progress.8.8. Coordination with social welfare Coordination with social welfare

department and working jointly.department and working jointly.

Challenges of CBRChallenges of CBR

Lack of understanding of concept.

Rapid turn over of civil servants, Finance / Prioritization.

Acceptance of CBR as a valid intervention.

Poor Management / planning of CBR

Inter Ministerial Rivalry - Lack of Inter Ministerial Rivalry - Lack of communicationcommunication

Evidence based facts not made availableEvidence based facts not made available Lack of co-ordination between the Lack of co-ordination between the

Government and NGO’sGovernment and NGO’s Social welfare department often has a Social welfare department often has a

weak structure at community level.weak structure at community level.

We look forward to a tomorrowWe look forward to a tomorrow

that includes PWDs in the mainstream as equal partners

that does not side stream PWDs

Community Based Rehabilitation

Health & Medicine

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