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Define CBR. Explain the need for CBR. Explain about the WHO model of CBR

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"community-based rehabilitation"

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WHO community-based rehabilitation CBR guidelines matrix health education livelihood social empowerment

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Definition of CBR

Community-Based Rehabilitation (CBR) is a strategy within general community development aimed at the rehabilitation, equalization of opportunities, social inclusion, and improved quality of life of persons with disabilities.
It is implemented through the combined efforts of:
  • Persons with disabilities
  • Their families
  • Community members and organizations
  • Governmental and non-governmental health, education, vocational, social, and other services
This WHO definition is reproduced in Park's Textbook of Preventive and Social Medicine.
CBR is therefore not only medical rehabilitation. It is a multisectoral, community-led approach that promotes inclusion, participation, independence, and rights of persons with disabilities.

Need for CBR

CBR is needed because institution-based rehabilitation services alone cannot meet the needs of all persons with disabilities, especially in low-resource and rural settings.
  1. Limited availability of specialized services
    Rehabilitation centres, specialists, physiotherapists, and assistive-device services are often concentrated in cities. CBR brings basic support nearer to the person's home.
  2. Large unmet need for rehabilitation
    Many people with disabilities do not receive early detection, treatment, training, follow-up, education, livelihood support, or social assistance.
  3. Accessibility and affordability
    Travel, cost, distance, and dependence on family members can prevent people from attending centre-based services. CBR uses local resources and reduces these barriers.
  4. Promotes functional independence
    It helps people gain maximum possible ability in activities of daily living, mobility, communication, self-care, education, and work.
  5. Addresses social stigma and exclusion
    Disability may lead to isolation, discrimination, school exclusion, unemployment, and poverty. CBR works with families and communities to change attitudes and support inclusion.
  6. Supports families and caregivers
    Families are taught home care, exercises, prevention of complications, use of assistive devices, and ways to encourage independence.
  7. Encourages education and employment
    Rehabilitation is incomplete without opportunities for schooling, vocational skills, self-employment, wage employment, and financial support.
  8. Promotes equal rights and participation
    CBR enables persons with disabilities to participate in decision-making, community life, self-help groups, and organizations of persons with disabilities.
  9. Uses local community resources
    It links health, education, social welfare, livelihood programmes, voluntary agencies, and local government services, making rehabilitation more practical and sustainable.

WHO Model of CBR: The CBR Matrix

The WHO CBR model is represented by the CBR Matrix. It has five major components, with five elements under each component. It shows that disability inclusion requires action beyond health care.
ComponentMain elements
1. HealthHealth promotion, prevention, medical care, rehabilitation, assistive devices
2. EducationEarly childhood, primary education, secondary and higher education, non-formal education, lifelong learning
3. LivelihoodSkills development, self-employment, wage employment, financial services, social protection
4. SocialPersonal assistance, relationships/marriage/family, culture and arts, recreation/leisure/sports, access to justice
5. EmpowermentAdvocacy and communication, community mobilization, political participation, self-help groups, organizations of persons with disabilities

1. Health component

The aim is to ensure that persons with disabilities can access the same health services as everyone else.
It includes:
  • Health promotion: Nutrition, sanitation, healthy lifestyle, health education.
  • Prevention: Immunization, antenatal care, prevention of injuries and disability, early identification.
  • Medical care: Diagnosis, treatment, referral, and follow-up.
  • Rehabilitation: Physiotherapy, occupational therapy, speech therapy, training in daily activities.
  • Assistive devices: Wheelchairs, crutches, calipers, hearing aids, spectacles, prostheses, and communication aids.

2. Education component

The aim is inclusive education and lifelong learning.
It includes:
  • Early childhood education
  • Primary education
  • Secondary and higher education
  • Non-formal education, such as literacy classes and community learning
  • Lifelong learning, including continuing education and skills training
The focus is to make mainstream schools accessible and supportive rather than segregating children with disabilities.

3. Livelihood component

The aim is economic independence and protection from poverty.
It includes:
  • Skills development
  • Self-employment
  • Wage employment
  • Financial services, such as loans, savings, and microcredit
  • Social protection, including pensions, disability benefits, insurance, and income-support schemes

4. Social component

The aim is full participation in family and community life.
It includes:
  • Personal assistance, including caregiver support and accessible housing
  • Relationships, marriage, and family life
  • Culture and arts
  • Recreation, leisure, and sports
  • Access to justice and protection from discrimination, violence, and exploitation

5. Empowerment component

This is central to the WHO model. Persons with disabilities must be active participants rather than passive recipients of services.
It includes:
  • Advocacy and communication
  • Community mobilization
  • Political participation
  • Self-help groups
  • Organizations of persons with disabilities
The 2010 WHO CBR Guidelines describe CBR as a strategy to strengthen access to health, education, livelihood, and social opportunities, while emphasizing empowerment, participation, and inclusion.

Key point

The WHO CBR model moves rehabilitation from a narrow medical approach to a rights-based, inclusive community-development approach. Its ultimate goal is that persons with disabilities live with dignity, participate fully in society, and have equal opportunities.
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