Community Based Rehabilitation

"Community-based rehabilitation (CBR) is a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights. It calls for the full and co-ordinated involvement of all levels of society: community, intermediate and national.

It seeks the integration of the interventions of all relevant sectors - educational, health, legislative, social and vocational - and aims at the full representation and empowerment of disabled people. It also aims at promoting such interventions in the general systems of society, as well as adaptations of the physical and psychological environment that will facilitate the social integration and the self-actualization of disabled people.

Its goal is to bring about a change; to develop a system capable of reaching all disabled people in need and to educate and involve governments and the public. CBR should be sustained in each country by using a level of resources that is realistic and maintainable.

CBR focuses on enhancing the quality of life for people with disabilities and their families, meeting basic needs and ensuring inclusion and participation.
CBR is a multi-sectoral approach and has 5 major components: health, education, livelihood, social and empowerment.

CBR was developed in the 1980s, to give people with disabilities access to rehabilitation in their own communities using predominantly local resources.
A 2004 joint ILO, UNESCO and WHO paper repositioned CBR as a strategy for rehabilitation, equalization of opportunity, poverty reduction and social inclusion of people with disabilities.

The goals of CBR are to ensure the benefits of the Convention on Rights of Persons with Disabilities reach the majority by:

• supporting people with disabilities 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;
• activating communities to promote and protect the human rights of people with disabilities for example by removing barriers to participation;
• Facilitating capacity building, empowerment and community mobilization of people with disabilities and their families.
CBR is implemented in more than 90 countries through the combined efforts of people with disabilities, their families, communities, and relevant governmental and non-governmental organizations working in disability and development. Involvement and participation of people with disabilities and their families is at the heart of CBR.
CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" (WHO, 1994).

It differs from Independent Living in that, according to Lysack (1994), the entire community is the target of CBR programs; the CBR model is one of community development or partnership; ILO ideology places control squarely with disabled consumers.

The CBR principles

The Guidelines are built on some basic and important principles. These are inclusion, participation, sustainability, empowerment, self-advocacy and a barrier free environment.

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

1. Inclusion

It is the act or practice which ensures including people with disabilities in community life. It is like what everyone else is, and being welcomed, valued and embraced as an equal member of the community.
Inclusion also means placing disability issues and people with disabilities in the mainstream of activities, rather than as an after-thought or ‘bolt-on’.
Inclusion also means ‘convergence’ – that is, the involvement of people with disabilities in the campaigns, struggles and activities of other oppressed groups which are not centered exclusively on disability issues, such as children living on the streets, farmers, land rights and environment, women’s groups. It means including people with multiple and/or severe disabilities.

2. Participation

Participation means the involvement of disabled people 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.

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

Participation requires the imaginative and flexible use of language and communication: for example ways around the barriers of illiteracy; the right to use your own language without discrimination or stigma.

3. Sustainability

Firstly, the benefits of the programme must be lasting. This means an approach to poverty alleviation where the socio-economic gains last beyond the short-term and benefit not just the present but future generations too.

Secondly, the CBR activity 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.

Strong links between government organizations, NGOs, community-based / development organizations and disabled peoples’ organizations will contribute towards sustainability.
This means that disabled people’s organizations and self-help groups – are the hub of any CBR activity.

4. Empowerment

Empowerment means that local people – and specifically people with disabilities and their families – make the programme decisions and control the resources. It means people with disabilities taking leadership roles within programmes.

It means ensuring that CBR workers, service providers and facilitators are people with disabilities and all are adequately trained and supported.

To empower means drawing strength from solidarity and guarding against ways in which institutions and individuals may work to ‘divide and rule’ between groups within the community.

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.

The skills of CBR workers and their managers are crucial too. They need to be empowered by ensuring they have a range and depth of skill appropriate to the complexities of the work.

Their training should include an understanding of the causes and effects of poverty, and the contribution the CBR programme can make to poverty alleviation. CBR workers are themselves often poor and have many other responsibilities. Training and support needs to acknowledge this reality.

5. Self Advocacy

Self-advocacy means the central and consistent involvement of people with disabilities defining for themselves the goals and processes for poverty alleviation. Family members will also play a key role as advocates.

Self-advocacy is a collective notion not an individualistic one. It means self-determination. It means mobilizing, organizing, representing, creating space for interaction and demands. It may mean posing a threat, making a challenge. These are the self-advocacy tools used in any CBR strategy.

6. A Barrier free Environment

Barriers are factors in a person's environment that, through their absence or presence, limit functioning and create disability. These include aspect such as the physical environment that is inaccessible as well as the negative attitudes of society or community towards people with disabilities and even towards their families.

The commonest examples of physical barriers are steps or inaccessible buses for people with mobility impairments.

People’s attitudes influence behaviour and social life at all levels, from interpersonal relationships and community associations to political, economic and legal structures. For example, the stigma and abuse of people with disabilities, leading to their marginalization and stereotyping.

Environmental factors are a major obstacle in inclusion. CBR needs to facilitate and ensure this, where possible.