Transcript A presentation of

A presentation of
COMMUNITY BASED
REHABILITATION FORUM
COMMUNITY BASED
REHABILITATION FORUM
An introduction to
C
Community B
Based R
Rehabilitation
of Persons with Disabilities
Mr. Nicholas Guia Rebelo
CBR Forum, Bangalore, India
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The emergence of the concept of
Community 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.”
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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.
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WHAT IS CBR?
CBR is a systematized approach
within general community development
whereby Persons with Disabilities are enabled
to live a fulfilling life
within their own community,
making maximum use of local resources
and helping the community become aware of it’s 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.
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The Joint position paper
defines CBR as:
 “a strategy within general community

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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 nongovernmental health, education, vocational,
social and other services.
What do we see in the picture?
Mainstream
Your Boat
Side stream
What if you are in the Mainstream?
What if you are in the Side stream?
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Mainstreaming and inclusion
• Mainstreaming 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
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Major Objectives
The major objectives of CBR as listed in the
joint position paper are:
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
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
 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.
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Evolution of
Concepts in CBR
• Disability 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.
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Evolution of
Concepts in CBR
• Human 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.
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Evolution of
Concepts in CBR
• Poverty
 There is a strong correlation between
disability and poverty.
 Poverty leads to increased disability, and
disability in turn leads to increased
poverty.
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Evolution of
Concepts in CBR
• Poverty
 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:
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Eradicate severe
poverty and
hunger.
Achieve
universal
primary
education.
None of these goals
can be effectively
achieved without the
inclusion of PWDs
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Evolution of
Concepts in CBR
• Inclusive Communities
 ‘Inclusive’ commonly used with reference
to educational provision that welcomes all
children. It can also be applied to policies
and services in health, skills training and
employment and to community life in
general.
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Evolution of
Concepts in CBR
• Inclusive Communities
 The concept of an inclusive community
means that communities adapt their
structures and procedures to facilitate the
inclusion of PWDs, rather than expecting
them to change to fit in with existing
arrangements.
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Evolution of
Concepts in CBR
• Role of DPOs
 An ideal CBR programme promotes DPOs:
 to enable PWDs to understand disability
and discrimination and
 to know about and access their rights.
 DPOs function at the level of various
administrative boundaries: village / district /
state
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Evolution of
Concepts in CBR
• Role of DPOs
 DPOs have the right and the responsibility:
 to identify the needs of all PWDs,
 to make their needs known and
 to promote appropriate measures to
address those needs
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Evolution of
Concepts in CBR
• Role of DPOs
 DPOs need:
 to educate all PWDs about their rights and
 to advocate for action to ensure the
realization of these rights
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Evolution of
Concepts in CBR
• Role of DPOs
 DPOs are made to play proactive and
meaningful roles in the initiation,
implementation and evaluation of CBR
programmes.
 DPOs are recognized as a resource
to strengthen CBR programmes.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
HOW
The principles are overlapping,
complimentary and interdependent – 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)
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Inclusion
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Inclusion
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Participation
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Participation
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Sustainability
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Sustainability
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Empowerment
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Empowerment
 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.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Advocacy
 Advocacy means the central and
consistent involvement of PWDs and their
families defining for themselves the goals
and processes for poverty alleviation.
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BASIC PRINCIPLES OF
A CBR PROGRAMME
• Advocacy
 Advocacy is a collective notion not an
individualistic one. It means selfdetermination.
 It means mobilizing, organizing,
representing, creating space for
interaction and demands.
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So far we have reflected on:
The emergence of the concept of CBR
The meaning (WHAT) of CBR
The Major Objectives of CBR
Evolution of concepts in CBR
Basic Principles of a CBR Programme:
inclusion, participation, sustainability, empowerment and advocacy
Any queries as of now?
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ESSENTIAL COMPONENTS OF
A CBR PROGRAMME
1.
The programme should cover all types of PWDs who need rehabilitation services.
2.
The programme should be 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.
The programme should aim at full integration of the PWD into his / her community.
5.
The programme needs to have committed and well trained community members as
service providers.
6.
The programme should have gender and disability focus and balance.
7.
The programme should strike a balance between provision of service delivery and
empowering the PWD, family and community through regular transfer of skills.
8.
The programme should facilitate the formation and strengthening of the disabled
people’s movement to ensure that the rights of the PWDs are not denied through
advocacy at local, state and national level.
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GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~
POVERTY ALLEVIATION
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PRINCIPLES: PARTICIPATION ~ INCLUSION ~ SUSTAINIBILITY ~ SELF ADVOCACY
HEALTH
EDUCATION
EMPOWERMENT
SOCIAL
PROMOTIVE
EARLY
CHILDHOOD
DEVELOPMENT
SKILLS
DEVELOPMENT
SELF-HELP
GROUPS
LEGAL
PROTECTION
PREVENTIVE
NON-FORMAL
INCOME
GENERATING
ACTIVITIES
DISABLED
PEOPLE'S
ORGANIZATION
CULTURE &
RELIGION
CURATIVE
FORMAL
SCHOOL
ACCESS TO
FINANCIAL
SERVICES
SOCIAL
MOBILISATION
SPORTS &
LEISURE
HIGHER
OPEN
EMPLOYMENT
POLITICAL
EMPOWERMENT
RELATIONSHIP
MARRIAGE &
FAMILY
ECONOMIC
CONTRIBUTION &
SOCIAL PROTECTION
LANGUAGE &
COMMUNICATION
REHABILITATIVE
ASSISTIVE
DEVICES
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LIVELIHOODS
SPECIAL/
TRANSITORY
PERSONAL
ASSISTANCE
WHO 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
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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.
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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.
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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.
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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.
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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.
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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.
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MOVING TOWARDS
AN 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
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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.
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COMPONENTS NEEDED
TO BEGIN A PROGRAMME FOR
THE 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 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.
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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 communication
Evidence based facts not made available
 Lack of co-ordination between the Government and NGO’s
 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.
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We look forward to a tomorrow
that does not side stream PWDs
that includes PWDs in the mainstream as equal partners
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