A presentation of

An introduction to Community Based Rehabilitation of Persons with Disabilities Mr. Nicholas Guia Rebelo CBR Forum, Bangalore, IndiaCBR

The emergence of the concept ofCommunity Based Rehabilitation If you give a person a fish, hell eat for a day;

if you teach him to fish, hell 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!The process of CBR as the name implies, has to have its roots in the community and has to derive sustenance and support from the community.

CBR is a systematized approach within general community developmentwhereby Persons with Disabilities are enabled to live a fulfilling life within their own community, making maximum use of local resourcesand helping the community become aware of its responsibility in ensuring the inclusion and equal participation of PWDs.In the process, PWDs are also made aware of their own role and responsibility, as they are part of the community.WHAT IS CBR?WHAT

The Joint position paper defines CBR as:a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities.CBR is implemented through the combined efforts of PWDs themselves, their families, organizations and communities, and the relevant governmental and non-governmental health, education, vocational, social and other services.

What do we see in the picture?MainstreamSide streamYour BoatWhat if you are in the Mainstream?What if you are in the Side stream?

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

In practical terms this means persons with disability are included in the programmes and schemes formulated by the government and others, not as mere beneficiaries but as equal members who can participate with full recognition and exercise their rights.Source: Mainstreaming Disability, ADD

Major ObjectivesThe major objectives of CBR as listed in the joint position paper are:

To ensure that PWDs are able to maximize their physical and mental abilities, to access regular services and opportunities, and to become active contributors to the community and society at large.

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

Evolution of Concepts in CBR Disability and Rehabilitation

Evolution of Concepts in CBR Disability and Rehabilitation

Evolution of Concepts in CBR Human Rights

Evolution of Concepts in CBR Poverty

Evolution of Concepts in CBR Poverty

Evolution of Concepts in CBR Inclusive Communities

Evolution of Concepts in CBR Inclusive Communities

Evolution of Concepts in CBR Role of DPOs

Evolution of Concepts in CBR Role of DPOs

Evolution of Concepts in CBR Role of DPOs

Evolution of Concepts in CBR Role of DPOs

BASIC PRINCIPLES OF A 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

BASIC PRINCIPLES OF A CBR PROGRAMME Inclusion

BASIC PRINCIPLES OF A CBR PROGRAMME Inclusion

BASIC PRINCIPLES OF A CBR PROGRAMME Participation

BASIC PRINCIPLES OF A CBR PROGRAMME Participation

BASIC PRINCIPLES OF A CBR PROGRAMME Sustainability

BASIC PRINCIPLES OF A CBR PROGRAMME Sustainability

BASIC PRINCIPLES OF A CBR PROGRAMME Empowerment

BASIC PRINCIPLES OF A CBR PROGRAMME Empowerment

BASIC PRINCIPLES OF A CBR PROGRAMME Advocacy

BASIC PRINCIPLES OF A CBR PROGRAMME Advocacy

Any queries as of now? So far we have reflected on:The emergence of the concept of CBRThe meaning (WHAT) of CBRThe Major Objectives of CBREvolution of concepts in CBRBasic Principles of a CBR Programme: inclusion, participation, sustainability, empowerment and advocacy

ESSENTIAL COMPONENTS OF A CBR PROGRAMMEThe programme should cover all types of PWDs who need rehabilitation services.The programme should be part of mainstream development and have a multi-sectoral approach : including social integration interventions, health, education and economic programmes.The programme should have access to or generate a good and effective referral system.The programme should aim at full integration of the PWD into his / her community.The programme needs to have committed and well trained community members as service providers.The programme should have gender and disability focus and balance.The programme should strike a balance between provision of service delivery and empowering the PWD, family and community through regular transfer of skills.The programme should facilitate the formation and strengthening of the disabled peoples movement to ensure that the rights of the PWDs are not denied through advocacy at local, state and national level.

GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~ POVERTY ALLEVIATIONWHO MATRIX

Multi-sectoral Support for CBR Support from the Social Sector:Examples: disability pensions, technical aids and adaptations, housing, vocational training and employment, and co-ordination of referrals for individuals who require services from other sectors

Multi-sectoral Support for CBR Support from NGOs and the local community:Most communities have a variety of non-governmental organizations (NGOs) and groups that can contribute to a CBR programme.

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

Multi-sectoral Support for CBR Support from the Health Sector:PHC can play a major role in this context both as a provider and supporter:Early identification of impairments and providing basic interventions. Referrals to specialized services such as physical, occupational and speech therapies; prosthetics and orthotics; and corrective surgeries.

Multi-sectoral Support for CBR Support from the Educational Sector:The educational sector can make an important contribution to CBR by assisting community schools within the regular school system to become more inclusive. This involves, for instance, adapting the content of the curriculum and methods of teaching. Ensuring that classrooms, facilities and educational materials are accessible. Children with multiple or severe disabilities who might require extensive additional support may access education through the use of innovative methods best suited to their context.

Multi-sectoral Support for CBR Support from the Employment and Labour Sector:Collaboration with the employment and labour sectors is essential to ensure that both youth and adults with disabilities have access to training and work opportunities at community level. Productive and decent work in a conducive environment is essential for the social and economic integration of individual PWDs.Equal employment opportunities through national policies and legislation; open labour market; apprenticeships with master trainers or local businesses; on-the-job training; mentoring entrepreneurs with disabilities and providing advice on current and emerging skills requirements to vocational training centres; access to credit and self employment.

Multi-sectoral Support for CBR Support from the Media :All CBR stakeholders should work closely with the media to identify priorities and to provide relevant information.

MOVING TOWARDS AN EFFECTIVE CBR PROGRAMMEThe following aspects of CBR need to be strengthened to make programmes more effective:Community Involvement and OwnershipMulti-sectoral collaboration in CBR programmesInvolvement of DPOs in CBR programmesScaling up CBR programmesCBR programmes to be used as an effective tool for poverty reductionEvidenced based practice

Who Initiates CBR ?Community action for CBR is often initiated by a stimulus from outside the community, most likely ministries or NGOs. Following initial discussions with representatives from outside the community, ideally it is the community which decides whether CBR will become part of its ongoing community development activities.

COMPONENTS NEEDED TO BEGIN A PROGRAMME FOR THE REHABILITATION OF PWDsLook out for. An action area where the need is apparent.A community which is receptive. A resourceful and creative outside agency. Persons with Disabilities who need the services of an external agency as well as the community for mainstreaming themselves, in order to set themselves up as contributors and not just recipients of service.

Challenges of CBR Lack of understanding of concept. Rapid turn over of civil servants. Acceptance of CBR as a valid intervention. Finance / Prioritization. Poor Management / planning of CBR Inter Ministerial Rivalry - Lack of communicationEvidence based facts not made available Lack of co-ordination between the Government and NGOs Absence of a coherent community level strategy Limited competence and capacity of decentralizing services Limited models of good practices Social welfare department often has a weak structure at community level Government is preoccupied with basic needs Governments do not include disability as a cross cutting issue.

We look forward to a tomorrowthat includes PWDs in the mainstream as equal partners