What is community-based rehabilitation?

Publicerad: 2004-10-10

Definitions:

Rehabilitation includes all measures aimed at reducing the impact of disability for an individual, enabling him or her to achieve independence, social integration, a better quality of life and self-actualisation.
Rehabilitation includes not only the training of disabled people but also interventions in the general systems of society, adaptations of the environment, protection of human rights and empowerment.
Protection of human rights is an obligation for the authorities of each country, for its communities and for every citizen. Disabled people shall have the same rights to a life in dignity as others, and there must be no exceptions. Special attention may be needed to ensure the following: access to health and social services; to education: ability training and income generation opportunities: to housing, transportation and to buildings; to information; to cultural and social life, including sports and recreational facilities; to representation and full political involvement in all matters of concern to them.

Community-based rehabilitation (CBR) is a common-sense strategy for enhancing the quality of life of people with disabilities by improving service delivery in order to reach all in need by, providing more equitable opportunities and by promoting and protecting their rights.
CBR builds on the full and co-ordinated involvement of people with disabilities and their families. It should be supported 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, promotes interventions in the general systems of society, and adaptations of the physical and psychological environment that will facilitate the inclusion and the self-actualisation of disabled people. The goal of CBR 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.

Suggestions for appropriate action at different levels: At the community level, CBR is seen as a component of an integrated community development programme. It should be based on decisions taken by its members. It will rely as much as possible on the mobilisation of local resources. The family of the disabled person is the most important resource. Adequate training and supervision should promote its skills and knowledge, using a technology closely related to local experience. The community should support the basic necessities of life and help the families who carry out rehabilitation at home. It should further open up all local opportunities for education, functional and ability training, jobs, etc. The community needs to protect its disabled members to ensure that they are not deprived of their human rights. Disabled community members and their families should be involved in all discussions and decisions regarding services and opportunities provided for them. The community will need to select one or more of its members to undergo training in order to implement the programme. A community structure (committee) should be set up to provide the local management.
At the intermediate level, the government should provide a network of support services. Its personnel should be involved in the training and technical guidance of community personnel, should provide services and managerial support, and should liaise with referral services.
Referral services are needed to receive those disabled people who need more specialised interventions than the community can provide. The CBR system should seek to draw on the resources available both in the governmen-tal and non-governmental sectors.
At the national level, CBR seeks the involvement of the government in the leading managerial role. This concerns policy-making, planning, implementing, co-ordinating, and evaluating the CBR system. This should be done in co-operation with the communities, the intermediate level and the non-governmental sector, including organisations of disabled people.

Comment: CBR is not a blueprint or ready-made solution. It calls for flexibility, taking into consideration the social, cultural and economic situation, the daily realities as experienced by persons with disabilities, the country’s existing services and personnel, and its phase of development, priorities and policies.
Projects or programmes that do not apply the basic principles of CBR, on the other hand, should use another term to describe their activities.

Einar Helander