Detailed note on community based rehabilitation marks 10

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

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Community-Based Rehabilitation (CBR)

Definition

Community-based rehabilitation (CBR) is a strategy within general community development that aims at the rehabilitation, equalization of opportunities, and social inclusion of persons with disabilities. It is carried out through the joint efforts of persons with disabilities, their families, community members and organizations, and government and non-governmental services. Park's Textbook of Preventive and Social Medicine describes CBR as requiring sustained, coordinated medical, social, educational, and vocational action.

The WHO CBR guidelines view CBR as a means to improve quality of life, meet basic needs, ensure participation, and empower persons with disabilities and their families.

Objectives

To enable persons with disabilities to attain the maximum possible physical, mental, social, and vocational independence.
To ensure equal opportunities in education, employment, social life, and community participation.
To promote early detection, treatment, prevention of further disability, and referral.
To reduce stigma, discrimination, neglect, and social isolation.
To involve families and communities in rehabilitation.
To promote the rights, dignity, self-reliance, and empowerment of persons with disabilities.

Principles of CBR

Community participation: The local community identifies needs and participates in planning, implementation, and evaluation.
Family involvement: The family is trained to provide daily support, home care, and encouragement.
Use of local resources: Uses available community workers, schools, primary health centres, voluntary agencies, and local materials.
Multisectoral coordination: Health, education, social welfare, livelihood, housing, and vocational services work together.
Equity and inclusion: Persons with disabilities should access the same services and opportunities as others.
Empowerment: Persons with disabilities participate in decisions affecting their lives.
Appropriate referral: Cases needing specialist care are referred to higher centres.

Components of the CBR Matrix

The WHO CBR matrix has five major components:

Component	Examples of activities
1. Health	Health promotion, prevention of disability, early identification, medical treatment, physiotherapy, provision of aids and appliances, referral services
2. Education	Early childhood education, inclusive schooling, special education where required, adult education, vocational training
3. Livelihood	Skills training, self-employment, wage employment, microcredit, social protection, income-generation activities
4. Social	Personal assistance, accessible transport and buildings, recreation, sports, cultural participation, marriage and family support
5. Empowerment	Formation of disabled persons' organizations, self-help groups, advocacy, awareness of rights, participation in community decisions

Activities at Community Level

Survey and identification of persons with disabilities.
Assessment of functional limitations and family needs.
Health education regarding causes and prevention of disability.
Training in self-care, mobility, activities of daily living, and use of assistive devices.
Home-based physiotherapy and occupational activities.
Provision or repair of simple aids such as crutches, splints, wheelchairs, hearing aids, and spectacles.
School enrolment and support for inclusive education.
Vocational rehabilitation, job placement, and income-generation activities.
Social security benefits, disability certificates, pensions, and travel concessions.
Community awareness programmes to reduce stigma.
Formation of self-help groups and referral linkages with district rehabilitation services.

Role of Health Worker

The community health worker, ASHA, ANM, or multipurpose worker can:

Identify disability early during home visits.
Educate the family regarding prevention of complications.
Teach basic exercises, positioning, skin care, and self-care.
Encourage school attendance and social participation.
Facilitate disability certification and welfare benefits.
Refer patients requiring specialist rehabilitation, surgery, physiotherapy, audiology, or orthotic services.
Maintain records and conduct follow-up visits.

Advantages

Services reach people in rural and underserved areas.
Cost-effective because local resources and family support are used.
Encourages self-reliance and community ownership.
Reduces institutional dependence.
Improves access to education, employment, and social participation.
Helps reduce stigma by integrating persons with disabilities into everyday community life.

Limitations

Inadequate trained personnel and supervision.
Limited funds, equipment, and referral facilities.
Stigma and negative attitudes in the community.
Poor coordination between health, education, and welfare sectors.
Risk of low-quality services if community workers are not adequately trained.

Conclusion

CBR is not merely home-based medical care. It is a community development and rights-based approach that combines health care, education, livelihood, social inclusion, and empowerment. Its success depends on active participation of the person with disability, family, community, government, and voluntary organizations.

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