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.
What is CBR ?
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.
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.