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What is Community Based Rehabilitation?


 

The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the end absence of illness." People living with disabilities who may present with various physical and mental challenges, further experience exclusion in their communities through physical and attitudinal barriers that creates occupational and social injustice.


Community-based Rehabilitation (CBR) initiation was a joint effort by WHO and United Nations (UN) in 1970s, they put together a training manual that was revised in 1989, and a joint position paper was produced in 1994 by the International labour 0rganization( ILO), WHO and UN. This paper was reviewed again in 2004 where it is stated:


" CBR is a strategy for rehabilitation, equalization of

opportunities, poverty reduction and inclusion of people with disabilities"


The Players in CBR


For CBR to be a success, it is imperative that the participation of various entities is incorporated to ensure devise representation of issues and for the program to get the support it needs.

  • People with disabilities and their families.

  • The community

  • NGOs

  • Relevant government departments


The Evolution of CBR


CBR has had to evolve from the time of its inception to accommodate new views that focus on a variety of issues that affect people with disabilities and exclude them from their communities, preventing them from reaching their full potential. Some of these factors include:

  • Disability is no longer viewed as barely the absence of impairment. Incorporation of the social model brings awareness that social barriers to participation are the major causes of disability.

  • Rehabilitation services are no longer imposed on clients but given with informed consent and recipients should have a say on the services they want.

  • Human rights; CBR promotes the rights of people with disabilities to have equal rights as citizens and to enjoy health and well-being to participate fully in educational, social, cultural, religious, economic and political activities.

  • A direct link between disability and poverty has led to an emphasis on poverty eradication and economic inclusion for people with disability.

  • Inclusive communities; Promotion of education for all to include full participation of children with disabilities in regular classrooms or other learning centres. Inclusion is now applied in all aspects of the community.


Initiating and supporting CBR

CBR is most often initiated by the support of those outside the respective communities but it is important that the community decides whether the program can be part of their development after looking at the needs of people with disabilities and whether CBR is the best way to handle those needs.


  • A notable trend has been that most CBR programs have been successful where there is an NGO in the area which constantly supports the program.

  • There should be a leadership structure within the community that can be supported by NGOs and government bodies.

  • Different government departments can also collaborate to support CBR programs by implementing policies and providing training for CBR workers and necessary resources.


Community workers


Community workers are the volunteers that work directly with people with disabilities in their respective communities. They may be a person with a disability or their family member, health workers, social workers, teachers, community development officers, etc who help to coordinate CBR services. They act as advocates for the people with disabilities as well as a source of information to link them to other services. They provide basic rehabilitation services to people with disabilities through capacity building by the larger CBR structure.


The role of various sectors in supporting CBR





Emergent concerns

  • The need to be gender-inclusive

  • CBR needs to be expanded to larger cities with slums

  • A focus on emergent areas such as refugee camps

  • Inclusion of all the age groups that require the support of CBR.

 

What does this mean for Occupational Therapists?

Occupational therapists play a critical role in CBR by:

  • Promoting inclusion within communities

  • Promoting for functional independence of people with disabilities

  • Bring back to often missing meaningfulness of activities

  • Advocating for occupational justice

  • Promoting occupational balance

  • How?

    • Exploring interests, conducting activity analyses, and conducting functional assessments that involve the person, and environment.

To successfully carry out these activities in a CBR program, OTs need to understand:

  • How to carry out a needs assessment.

  • The inherent cultures of each unique community

What skills do OTs need to develop for CBR?

  • Community mobilization

  • Interdisciplinary and multidisciplinary collaboration

  • Knowledge of the healthcare and political systems

  • Community collaboration


Occupational therapists need to take a proactive role in Community Based Rehabilitation.

 

Thank you for reading! We are always looking for new perspectives and stories to share. If you want to support our mission, share your stories and resources by getting in touch.



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