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We consider CBR to be a focused community development
programme in the field of disability prevention and
rehabilitation, that enables community members; to
obtain a better understanding of disability issues, and
provides a positive environment for, and improve the
quality of life of people with disabilities. Unsing the
philosophy of community development as a way of
implementing CBR led to seeking out better tools. One of
the newest approaches we learn from Action Aid India (SABALA)
during ‘Program Managers’ of CBR training in 2001 at
Bangalore to implementing community development
programmes is participatory rural appraisal (PRA) using
this method efficiently we are able to involve the
community in the process of developing CBR programmes
and to gather information about community attitudes,
priorities and needs. It helped the communities mobilize
their human and natural resources to define problems and
prepare a systematic and site-specific plan of action.
In this process our field staff view themselves as
resources that can act as facilitators, trainers and
helpers rather than doers. The major features of this
process are community meetings where directed activities
are used to focus on disability issues.
Cultural activities during community meetings are a
major crowed puller and we get the message right across
the illiterate community with tangible results. It helps
us to change the attitude of the community to the
disabled and change the fatalistic attitude of the
disabled themselves. We found the use of cultural
activities in PRA the most effective tool in planning
CBR and its implementation, monitoring and awareness
building. The success of any CBR greatly depends on
awareness building which in turn enabled greater
participation of the community.
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The concept of community-based rehabilitation (CBR) was
proposed by the World Health Organization (WHO) in the
late 1970s to increase the coverage of rehabilitation
services for disabled persons. Initially it focused on
medical and functional aspects of rehabilitation needs.
Soon afterwards other agencies of the United Nations,
United Nations Organization for Educational, Scientific
and Cultural Development (UNESCO) and International
Labour Organization (ILO) proposed similar approaches
for dealing with the educational and occupational
aspects of rehabilitation. Implementations of field
activities based on this approach, which values existing
resources, skills and capacities in the families and
communities, were known as the “WHO Model”, “UNESCO
Model” and “ILO Model” of CBR.
Gradually it became clear that, for CBR to be
effective, disabled persons require a multi-sectoral
approach that covers all aspects of life. It was also
evident that these activities related to medical,
social, psychological, educational and occupational
aspects have limited impact on the lives of persons with
disabilities and their families unless attitudes change
in the communities, unless there are effective national
policies and laws which guarantee equal opportunities to
all citizens, and unless persons with disability
themselves have the possibility of making choices and
are empowered to take decisions concerning their own
lives. This evolution in the concept of CBR resulted in
a collaboration involving WHO, UNESCO and ILO in 1994. A
paper entitled Joint Position Paper on CBR
ensued, which attempted to go beyond the different
“models”.
It defines CBR as: …a strategy within general
community development for rehabilitation, equalization
of opportunities and social inclusion of all children
and adults with disabilities. CBR is implemented through
the combined efforts of people with disabilities
themselves, their families and communities, and the
appropriate health, education, vocational and social
services.
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Rehabilitation cannot be dispensed over the counter and
must be realized as a process in which persons in the
community are intimately involved. The Community Based
approach aims at the most cost effective method,
reaching the largest number of persons and utilizing
readily available resources in the community.
The last decade has witnessed attempts to integrate
disability into community development projects that
showed some tangible benefits for disabled persons.
However disabled persons tend to be recognized only by
their disability and not by any other parameters such as
genger, poverty level, ethnic and so on is resulting in
their exclusion from the benefits of inclusion in a
development programme. Lack of mobility, education and
skills in disabled persons prevent them from being a
part of development programmes, while expectations of
charity and poor motivation on the part of the disabled
also contribute to their exclusion. It is against this
scenario CBR programme assume its importance. Community
Based Rehabilitation is now acknowledged as an effective
approach to solving problems associated with disability. |
