Community-Based Rehabilitation (CBR)

Definition

• Rehabilitation of persons with disabilities
• Equalization of opportunities
• Poverty reduction
• Social inclusion and participation of persons with disabilities

Need for CBR

1. Limited access to institutional rehabilitation

• Specialist rehabilitation centres are usually situated in urban areas.
• Rural populations and poor families may not be able to travel repeatedly to these centres.
• CBR brings basic rehabilitation services nearer to the home and village.

2. Shortage of rehabilitation professionals

• There are insufficient doctors, physiotherapists, occupational therapists, speech therapists and special educators, especially in low-resource settings.
• CBR uses trained community workers, family members and local resources under professional guidance.

3. Long-term nature of disability care

• Rehabilitation often requires sustained care, training, follow-up and counselling over months or years.
• Families and communities can provide daily support for exercises, self-care, mobility and skill development.

4. Promotes early identification and intervention

• Community workers can identify children and adults with disability early.
• Early referral, treatment, prevention of complications and use of assistive devices can reduce disability.

5. Improves independence and functional ability

• CBR helps persons with disabilities achieve the highest possible level of physical, psychological, social and vocational functioning.
• It promotes self-care, mobility, communication and performance of activities of daily living.

6. Addresses social stigma and discrimination

• Disability is often associated with stigma, exclusion and misconceptions.
• Community education promotes acceptance, dignity, equal rights and inclusion.

7. Supports education and livelihood

• Persons with disabilities may be denied schooling and employment.
• CBR facilitates inclusive education, vocational training, self-employment, wage employment and social security benefits.

8. Ensures participation of family and community

• Disability affects the whole family, not just the individual.
• CBR involves the person, family and community in planning and decision-making, making rehabilitation acceptable and sustainable.

9. Cost-effective use of local resources

• It reduces dependence on expensive institutions and repeated hospital visits.
• Local resources, self-help groups, voluntary agencies and government schemes can be used effectively.

10. Promotes rights-based inclusive development

• CBR shifts the approach from charity and dependence to rights, participation, empowerment and equal opportunity.
• It supports implementation of disability-inclusive policies and the UN Convention on the Rights of Persons with Disabilities.

WHO Model of CBR: The CBR Matrix

1. Health Component

Elements

1. Health promotion
   • Nutrition, hygiene, safe environment, healthy lifestyle and health education.
   • Encourages healthy practices among persons with disabilities and their families.
2. Prevention
   • Prevention of disease, injury, impairment and secondary complications.
   • Includes immunization, antenatal care, accident prevention and early detection of disability.
3. Medical care
   • Access to diagnosis, treatment, referral, medicines and specialist care.
   • Includes maternal and child health services and management of chronic illness.
4. Rehabilitation
   • Physiotherapy, occupational therapy, speech therapy, counselling, mobility training and self-care training.
   • Aims to improve functional capacity and independence.
5. Assistive devices
   • Provision, fitting, repair and maintenance of devices such as wheelchairs, crutches, calipers, hearing aids, spectacles and prostheses.

2. Education Component

Elements

1. Early childhood
   • Early stimulation, play, development assessment and parent guidance.
   • Early intervention is particularly important for children with developmental disabilities.
2. Primary education
   • Inclusion of children with disabilities in regular schools wherever possible.
   • Provision of accessible classrooms, teaching aids and support services.
3. Secondary and higher education
   • Equal opportunity for secondary school, college, technical education and professional courses.
4. Non-formal education
   • Adult literacy, basic education, home-based learning and community learning programmes.
5. Lifelong learning
   • Continued opportunities to learn new skills and update knowledge throughout life.

3. Livelihood Component

Elements

1. Skills development
   • Vocational training, career guidance and development of marketable skills.
2. Self-employment
   • Small businesses, home-based work, cooperatives and income-generating activities.
3. Wage employment
   • Equal access to jobs, reasonable workplace accommodation and protection from discrimination.
4. Financial services
   • Access to loans, savings groups, microcredit, insurance and banking facilities.
5. Social protection
   • Disability pension, travel concessions, subsidies, unemployment support and welfare schemes.

4. Social Component

Elements

1. Personal assistance
   • Support for daily living, mobility, communication and independent living.
2. Relationships, marriage and family
   • Respect for the right to friendship, marriage, parenthood and family life.
   • Counselling may be provided to individuals and families.
3. Culture and arts
   • Inclusion in cultural events, music, art, religious activities and local traditions.
4. Recreation, leisure and sports
   • Participation in games, sports, recreation and community events, including adapted sports.
5. Justice
   • Equal access to legal services, protection against abuse and discrimination, and awareness of legal rights.

5. Empowerment Component

Elements

1. Advocacy and communication
   • Raising awareness about disability rights and combating stigma and discrimination.
2. Community mobilization
   • Involving local leaders, families, schools, health workers and voluntary organizations in disability inclusion.
3. Political participation
   • Ensuring persons with disabilities can vote, participate in local governance and influence policies.
4. Self-help groups
   • Groups that provide mutual support, savings, problem-solving and collective action.
5. Disabled persons' organizations
   • Organizations led by persons with disabilities that advocate for rights, services and inclusion.

Conclusion