1. Definition of rehabilitation

2. Rehabilitation process - flow chart

Person with illness / injury / disability
                  ↓
Assessment of physical, psychological, social,
vocational and environmental needs
                  ↓
Identification of problems and setting goals
                  ↓
Individualized rehabilitation plan
                  ↓
Interventions by rehabilitation team
(medical care, physiotherapy, occupational therapy,
counselling, social and vocational support)
                  ↓
Training for activities of daily living and independence
                  ↓
Family education and community support
                  ↓
Vocational placement / social reintegration
                  ↓
Follow-up, reassessment and modification of plan

3. Members of the rehabilitation team

• Patient and family members
• Physiatrist or rehabilitation physician
• Medical specialist or surgeon, as needed
• Nurse
• Physiotherapist
• Occupational therapist
• Speech and language therapist
• Audiologist
• Psychologist or counsellor
• Social worker
• Prosthetist and orthotist
• Vocational counsellor and placement officer
• Special educator
• Dietitian
• Community health worker

4. Types of rehabilitation

1. Medical rehabilitation
   Restores physical function and minimizes disability.
2. Vocational rehabilitation
   Restores or develops the person's ability to earn a livelihood.
3. Social rehabilitation
   Restores family relationships, social roles, and participation in community life.
4. Psychological rehabilitation
   Restores confidence, self-esteem, dignity, and emotional adjustment.

5. Definition of society

6. Definition of community

7. Three characteristics of a good community

1. Common purpose and cooperation
   Members work together to meet shared needs and solve local problems.
2. Healthy and safe environment
   The community has safe water, sanitation, housing, education, healthcare, and protection from hazards.
3. Active participation and mutual support
   People participate in decisions, support one another, respect diversity, and promote social harmony.

5. Society

Main elements of society

1. A group of people
   Society consists of people living and interacting together.
2. Social relationships
   Members have relationships such as family relationships, work relationships, friendships, and neighbourhood connections.
3. Common culture
   Members share, to varying degrees, language, customs, beliefs, traditions, values, and ways of life.
4. Social organization
   Society has organized institutions, for example:
   • Family
   • School
   • Religion
   • Government
   • Health services
   • Economic institutions
5. Rules and norms
   Members follow accepted rules, laws, customs, and standards of behaviour that maintain order.
6. Cooperation and interdependence
   Individuals depend on one another for food, shelter, education, employment, security, healthcare, and emotional support.

Example

6. Community

Components of a community

1. People
   A community must have a group of individuals or families.
2. Locality or geographical area
   Members may live in the same village, town, ward, colony, or district.
3. Common interests and needs
   Members may share needs such as water supply, sanitation, education, roads, safety, and health services.
4. Interaction
   Community members communicate, cooperate, and take part in common activities.
5. Sense of belonging
   Members identify themselves as part of that community.
6. Common resources and services
   These may include schools, health centres, markets, religious places, roads, water sources, and community halls.

Examples of community

• A village community
• An urban slum community
• A school community
• A religious community
• A workplace community
• A community of people with disabilities

Difference between society and community

7. Characteristics of a good community

Three important characteristics

1. Community participation and cooperation

• Villagers participate in cleaning campaigns.
• Local groups help organize immunization programmes.
• Residents work together to improve drainage or drinking-water supply.
• People attend community meetings and voice their needs.

2. Healthy, safe, and clean environment

• Safe drinking water
• Proper sanitation and waste disposal
• Clean surroundings
• Adequate housing and ventilation
• Safe roads and public places
• Control of pollution
• Access to healthcare services
• Protection from violence, accidents, and disasters

3. Mutual respect, social harmony, and support

• Neighbours help families during illness or emergencies.
• Children and women are protected from abuse and discrimination.
• Persons with disabilities are included in school, work, and community activities.
• Community members settle conflicts peacefully.

Other characteristics of a good community

• Availability of education and employment opportunities
• Accessible health services, including preventive and rehabilitative services
• Equality and social justice
• Effective leadership
• Awareness about health, hygiene, nutrition, and disease prevention
• Ability to identify and solve community problems
• Care for the environment
• Preparedness for emergencies and disasters

1. Community concepts
   • Types of community
   • Village and urban communities
   • Characteristics of Indian villages
   • Changes in rural life
2. Rural local self-government
   • Panchayati Raj system and its three levels
3. Urban health
   • Features of urban communities
   • Causes of urban health problems
   • Strategies for improvement
4. Community entry
   • Community door
   • Community entry process
   • Role and advantages of contact persons
5. Community-based rehabilitation (CBR)
   • WHO CBR Matrix: health component
   • WHO CBR Matrix: education component

1. Community types, village and rural life
2. Panchayat system
3. Urban community and urban health
4. Community entry and contact persons
5. WHO CBR Matrix components

8. Types of community

A. Based on geographical location

1. Rural community
   A community located in villages or countryside, where agriculture and allied occupations are common.
2. Urban community
   A community located in towns and cities, usually characterized by high population density, diverse occupations, industries, and better transport and communication facilities.
3. Tribal community
   A community of indigenous people living in a particular geographical area, often sharing common language, culture, customs, traditions, and social organization.

B. Based on common interests or identity

1. Religious community
   People connected by a common religion, faith, or place of worship.
2. Occupational community
   People having a common occupation, such as teachers, farmers, fishermen, factory workers, or health workers.
3. Educational community
   People associated with an institution, such as a school, college, or university.
4. Cultural or ethnic community
   People who share common culture, language, customs, or ethnic identity.
5. Virtual community
   People connected through the internet or social media because of common interests, even though they may live in different places.

9. Features of village community

Features

1. Small size of population
   Villages generally have a smaller population than cities. People often know each other personally.
2. Agriculture-based economy
   Farming, animal husbandry, fishing, forestry, and other allied occupations are important sources of livelihood.
3. Close personal relationships
   Social relationships are direct, intimate, and informal. Family members, neighbours, and relatives often support each other in daily life and during illness or emergencies.
4. Homogeneity
   People may have similar customs, language, religion, occupations, food habits, and way of life. However, Indian villages may also have caste, class, religious, and economic differences.
5. Strong family system
   Joint families or extended families are traditionally common. Elders often have an important role in family decisions.
6. Social control through customs and traditions
   Behaviour is influenced by traditions, religious beliefs, family values, village elders, and community opinion.
7. Simple way of life
   Rural life is often less formal and less complex than urban life. Daily activities are closely linked to seasons and agricultural work.
8. Limited facilities in some areas
   Health services, schools, transport, employment, sanitation, safe water, electricity, and communication may be limited, especially in remote villages.
9. Dependence on nature
   Agriculture and income are influenced by rainfall, climate, soil, water availability, floods, droughts, and other environmental conditions.
10. Community cooperation
    Villagers may cooperate during farming, marriages, festivals, funerals, disasters, construction work, and health programmes.

10. Characteristics of Indian villages

1. Agriculture is the major occupation
   Most rural households depend directly or indirectly on farming, livestock, dairy, fisheries, forest products, or agricultural labour.
2. Low population density
   Houses are less densely packed than in cities, except in some large or peri-urban villages.
3. Caste and social stratification
   Caste, class, land ownership, gender, and economic status may influence occupation, housing, social relationships, access to resources, and leadership.
4. Traditional social structure
   Customs, rituals, religion, local beliefs, and family traditions have an important role in village life.
5. Strong kinship relationships
   Families and relatives are closely connected. Social support is often strong, though it may also restrict individual choices in some settings.
6. Panchayati Raj institutions
   Local governance occurs through Gram Sabha, Gram Panchayat, Panchayat Samiti, and Zilla Parishad.
7. Limited employment opportunities outside agriculture
   Seasonal unemployment and underemployment may occur. This may result in migration to towns and cities.
8. Health and sanitation challenges
   Some villages may face inadequate water supply, open dumping of waste, poor drainage, unsafe sanitation, malnutrition, communicable diseases, and limited access to specialist health services.
9. Lower access to education and technology in remote areas
   Access has improved greatly, but some villages still have fewer schools, digital services, transport, and higher educational opportunities.
10. High dependence on government programmes
    Rural development, housing, sanitation, employment, maternal-child health, nutrition, water supply, and social welfare programmes are important for village development.
11. Community spirit and mutual help
    Cooperation is often seen in festivals, farming, village meetings, self-help groups, disaster response, and public health activities.

11. Panchayat system

Definition

Constitutional basis

• Establishment of Panchayats at village, intermediate, and district levels.
• Election every 5 years.
• Reservation of seats for Scheduled Castes and Scheduled Tribes according to their population.
• Reservation of not less than one-third of seats and chairperson positions for women. Many states provide 50% reservation for women.
• Formation of State Election Commissions.
• Formation of State Finance Commissions.
• Inclusion of 29 subjects in the Eleventh Schedule for possible devolution to Panchayats.

Three-tier Panchayat system

District level
      ↓
Zilla Parishad / Zilla Panchayat
      ↓
Block / Intermediate level
      ↓
Panchayat Samiti / Janpad Panchayat
      ↓
Village level
      ↓
Gram Sabha and Gram Panchayat

A. Village level

1. Gram Sabha

• Discusses village needs and development plans.
• Approves or reviews local development works.
• Participates in social audit of schemes.
• Discusses village budget and use of funds.
• Holds elected representatives accountable.
• Helps identify beneficiaries for welfare schemes.

2. Gram Panchayat

• Safe drinking-water supply
• Sanitation and waste disposal
• Drainage and cleanliness
• Village roads and street lighting
• Maintenance of community assets
• Birth and death registration support
• Health promotion and disease prevention
• Support for immunization, nutrition, maternal-child health, and family welfare programmes
• Implementation of government welfare schemes
• Local development planning

3. Nyaya Panchayat

B. Block level: Panchayat Samiti

• Coordinates the work of Gram Panchayats.
• Plans and implements block-level development programmes.
• Provides technical guidance to village Panchayats.
• Supervises agriculture, education, health, sanitation, roads, and rural development schemes.
• Distributes and monitors funds for block-level programmes.

C. District level: Zilla Parishad

• Prepares district development plans.
• Coordinates Panchayat Samitis.
• Allocates resources across blocks.
• Supervises rural development programmes.
• Coordinates activities related to health, education, agriculture, roads, water supply, and social welfare.

12. Changes in Indian rural life

Major changes

1. Improved transport and communication
   • Better roads, buses, rail links, mobile phones, television, and internet have reduced isolation.
   • Villagers can access information, markets, education, and health services more easily.
2. Agricultural modernization
   • Increased use of tractors, irrigation, improved seeds, fertilizers, pesticides, farm machinery, and agricultural extension services.
   • Greater diversification into dairy, poultry, fisheries, horticulture, and agro-processing.
3. Education and literacy
   • Greater school enrolment, especially among girls.
   • More young people pursue higher education and skilled employment.
4. Changing occupational pattern
   • Dependence on agriculture alone has reduced in many areas.
   • People work in construction, small businesses, government jobs, service industries, transport, and factories.
5. Migration
   • Rural people may migrate to cities or other states for employment, education, and better income.
   • This can improve family income through remittances but may also create social and family difficulties.
6. Changes in family structure
   • Joint families are declining in many places.
   • Nuclear families are increasing due to migration, education, employment, and changing values.
7. Improvement in healthcare
   • Expansion of primary health centres, sub-centres, ASHA workers, immunization, institutional delivery, maternal-child health services, and health insurance schemes.
   • Yet access to specialist and emergency care may remain difficult in remote areas.
8. Improved sanitation and housing
   • Increased use of household toilets, safer water sources, electricity, cleaner cooking fuels, and better housing in many areas.
   • Challenges remain in maintenance, water availability, drainage, and waste management.
9. Women’s participation
   • Greater participation of women in education, self-help groups, local governance, employment, and health decisions.
   • Gender inequality and violence still need attention.
10. Political awareness and local participation

• Gram Sabha meetings, Panchayati Raj, self-help groups, and welfare schemes have increased awareness of rights and participation in local development.

1. Changing social attitudes

• Some traditional restrictions related to caste, gender, and occupation are becoming less rigid.
• However, social discrimination and unequal access to resources may continue in some settings.

1. Digital transformation

• Digital payments, online education, telemedicine, e-governance, and mobile-based agricultural information are increasingly available.

13. Features of urban community

Features

1. Large population Cities and towns have a large number of people living in a limited area.
2. High population density Houses, apartments, offices, shops, industries, and transport systems are closely located.
3. Heterogeneous population Urban populations are diverse in language, religion, culture, caste, education, occupation, and economic status.
4. Non-agricultural occupations Common occupations include business, government service, teaching, healthcare, information technology, factory work, construction, transport, and domestic work.
5. Formal and impersonal relationships People may have less close contact with neighbours because of busy lifestyles, mobility, privacy, and diverse backgrounds.
6. Greater social mobility People can change occupation, income level, social status, and place of residence more easily than in traditional village settings.
7. Better availability of services Cities usually have more schools, colleges, hospitals, markets, banks, transport, communication facilities, and recreational centres.
8. Housing shortage and slums Rapid urbanization can lead to overcrowded housing, informal settlements, homelessness, and inadequate basic services.
9. High cost of living Housing, education, transport, and healthcare may be costly.
10. Environmental pollution Air, water, noise, industrial, and solid-waste pollution are common urban concerns.
11. High crime and social stress Unemployment, poverty, substance use, violence, isolation, and mental stress may occur.

14. Causes of diseases in urban community

A. Environmental causes

1. Overcrowding
   Promotes spread of respiratory infections, tuberculosis, diarrhoeal diseases, skin diseases, and infestations.
2. Poor housing and slums
   Inadequate ventilation, dampness, unsafe water, poor sanitation, and poor waste disposal increase disease risk.
3. Unsafe water and poor sanitation
   Lead to diarrhoea, typhoid, hepatitis A and E, cholera, intestinal parasitic infections, and other water-borne diseases.
4. Poor drainage and stagnant water
   Encourage mosquito breeding and increase dengue, malaria, chikungunya, and other vector-borne diseases.
5. Air pollution
   Vehicle exhaust, industries, dust, biomass smoke, and construction pollution can worsen asthma, chronic respiratory disease, heart disease, stroke risk, and lung cancer risk.
6. Noise pollution
   May contribute to stress, sleep disturbance, anxiety, reduced concentration, and hypertension.
7. Improper disposal of solid waste
   Promotes flies, rodents, stray animals, insects, foul odour, and contamination of water and food.

B. Social and economic causes

1. Poverty and unemployment
2. Homelessness and insecure housing
3. Migration and lack of social support
4. Illiteracy and lack of health awareness
5. Inequality in access to health services
6. Child labour and unsafe work conditions
7. Crime, violence, and substance use

C. Lifestyle-related causes

1. Sedentary lifestyle
2. Unhealthy diet, excess salt, sugar, and processed foods
3. Tobacco use
4. Alcohol and other substance use
5. Stress, inadequate sleep, and lack of exercise

D. Occupational causes

• Industrial accidents
• Chemical exposure
• Dust exposure
• Noise exposure
• Heat stress
• Long working hours
• Road traffic injuries
• Musculoskeletal problems

15. Strategies to improve urban health problems

Strategies

1. Provide safe drinking water
   • Regular testing and chlorination of water.
   • Repair leaking pipelines.
   • Promote safe household storage of water.
2. Improve sanitation
   • Adequate household and public toilets.
   • Safe sewage disposal.
   • Prevention of open defecation.
   • Maintenance of drains and toilets.
3. Strengthen solid-waste management
   • Waste segregation at source.
   • Door-to-door collection.
   • Recycling and safe disposal.
   • Control of open dumping and burning of waste.
4. Control vector-borne diseases
   • Remove stagnant water.
   • Cover water containers.
   • Improve drainage.
   • Conduct surveillance and vector-control activities.
   • Promote household and community participation.
5. Improve housing and slum development
   • Reduce overcrowding.
   • Improve ventilation, lighting, roads, drainage, toilets, water supply, and waste collection.
   • Provide secure, affordable housing.
6. Control air and noise pollution
   • Enforce industrial-emission standards.
   • Promote clean public transport, walking, and cycling.
   • Control vehicle emissions and construction dust.
   • Increase green spaces and tree cover.
   • Regulate noise levels.
7. Strengthen primary healthcare
   • Accessible urban primary health centres.
   • Maternal-child health services.
   • Immunization.
   • Screening for hypertension, diabetes, tuberculosis, cancer, and mental-health conditions.
   • Referral and follow-up services.
8. Health education and behaviour change
   • Education on handwashing, food hygiene, waste disposal, mosquito control, healthy diet, physical activity, tobacco cessation, and responsible alcohol use.
9. Prevent noncommunicable diseases
   • Promote exercise, healthy food, tobacco cessation, stress management, and regular health screening.
10. Road-safety measures

• Safe roads, footpaths, street lighting, helmets, seat belts, speed control, and enforcement of traffic laws.

1. Mental-health and substance-use services

• Counselling, crisis support, de-addiction services, early detection, and community awareness.

1. Community participation

• Involve resident welfare associations, women’s groups, youth groups, schools, local leaders, and slum communities in identifying and solving local health problems.

16. Community door

Examples of community doors

• Village Sarpanch or Panchayat member
• Village head or respected elder
• ASHA worker
• Anganwadi worker
• Auxiliary nurse midwife
• School teacher
• Religious leader
• Women’s self-help group leader
• Youth leader
• Community-based organization
• Local NGO
• Resident welfare association in an urban area
• Health-centre staff

Importance

• Understand the community structure.
• Gain permission and acceptance.
• Identify local leaders and key persons.
• Know community needs and resources.
• Communicate in a culturally appropriate way.
• Build trust before beginning a programme.

17. Advantages of using contact persons in community-entry strategies

Advantages

1. Builds trust quickly
   Community members are more willing to communicate when introduced by someone they know.
2. Improves acceptance of the health worker
   The contact person explains the purpose of the visit and reduces suspicion or fear.
3. Provides information about the community
   The person can explain local customs, leaders, language, beliefs, health problems, and available resources.
4. Helps identify key leaders and vulnerable groups
   The contact person can help reach older adults, pregnant women, persons with disabilities, children, migrants, and poor families.
5. Facilitates communication
   They may help with local language, timing of meetings, cultural practices, and appropriate ways to approach families.
6. Encourages participation
   When trusted local persons support a programme, community members are more likely to attend meetings and participate.
7. Saves time and resources
   The worker can locate households, facilities, groups, and local resources more efficiently.
8. Helps solve resistance and misunderstandings
   Contact persons may clarify rumours, fears, and misconceptions about health programmes.
9. Promotes continuity
   They can support follow-up, remind people about services, and maintain communication after the health worker leaves.
10. Supports sustainability
    Community involvement makes programmes more likely to continue successfully.

18. Community entry

Definition

Objectives of community entry

• To introduce oneself and the organization.
• To explain the purpose of the visit or programme.
• To gain permission and acceptance.
• To understand local culture, beliefs, customs, and power structure.
• To identify community needs, resources, leaders, and vulnerable groups.
• To involve people in planning, implementation, and evaluation.

Steps in community entry

1. Preparation before entry

• Collect basic information about the area.
• Understand the purpose and objectives of the programme.
• Learn about language, culture, religion, customs, and local issues.
• Identify possible leaders, agencies, and contact persons.
• Prepare necessary letters of introduction or permissions.

2. Identify the community door

3. Introduce yourself

4. Meet community leaders and members

5. Explain the programme clearly

• Why the programme is needed
• Who will benefit
• What activities will occur
• How community members can participate
• What support is expected from the community

6. Listen to community views

7. Assess community needs and resources

• Health problems
• Water and sanitation facilities
• Schools and health centres
• Local organizations
• Available workers and volunteers
• Vulnerable groups
• Existing strengths and resources

8. Build rapport and mutual trust

9. Involve the community in planning

10. Implement, monitor, and provide feedback

Principles of good community entry

• Respect for people and culture
• Community participation
• Transparency
• Equality and inclusion
• Active listening
• Cultural sensitivity
• Partnership rather than authority
• Confidentiality
• Accountability
• Use of local resources

19. Health component of WHO CBR Matrix

Health | Education | Livelihood | Social | Empowerment

1. Promotion
2. Prevention
3. Medical care
4. Rehabilitation
5. Assistive devices

1. Promotion

• Health education
• Nutrition education
• Physical activity
• Mental-health promotion
• Sexual and reproductive health education
• Prevention of stigma and discrimination
• Creating accessible health information

2. Prevention

• Immunization
• Antenatal and postnatal care
• Safe delivery
• Early detection of disability
• Prevention of accidents
• Prevention of pressure sores and contractures
• Infection control
• Nutrition programmes
• Screening and early treatment

3. Medical care

• Diagnosis and treatment
• Referral services
• Maternal and child healthcare
• Treatment of acute and chronic illness
• Surgery when needed
• Mental-health services
• Pain management
• Follow-up care

4. Rehabilitation

• Physiotherapy
• Occupational therapy
• Speech and language therapy
• Hearing and vision rehabilitation
• Mobility training
• Training in activities of daily living
• Psychosocial counselling
• Family training
• Vocational rehabilitation

5. Assistive devices

• Wheelchairs
• Crutches
• Walking sticks
• Prostheses
• Orthoses
• Hearing aids
• White canes
• Spectacles and low-vision aids
• Communication devices
• Adapted utensils and mobility aids

20. Education component of WHO CBR Matrix

1. Early childhood
2. Primary education
3. Secondary and higher education
4. Non-formal education
5. Lifelong learning

1. Early childhood

• Early identification of developmental delay or disability
• Early intervention
• Parent counselling and training
• Nutrition and health promotion
• Inclusive preschool and Anganwadi services
• Play and social-development activities

2. Primary education

• Enrolment in school
• Accessible classrooms and toilets
• Inclusive teaching methods
• Learning materials in suitable formats
• Teacher support
• Peer support
• Individual learning assistance
• Prevention of school dropout

3. Secondary and higher education

• Accessible secondary schools, colleges, and universities
• Scholarships and financial support
• Assistive technology
• Accessible transport
• Sign-language interpretation where needed
• Examination accommodations
• Career guidance and counselling

4. Non-formal education

• Adult literacy programmes
• Basic education for persons who have never attended school
• Bridge courses for school dropouts
• Community learning programmes
• Functional literacy
• Skill-oriented training

5. Lifelong learning

• Continuing education
• Digital literacy
• Health education
• Financial literacy
• Life-skills education
• Training in independent living
• Skills for employment and self-employment
• Community participation and leadership training