Community-Based Rehabilitation (CBR): Definition

• Rehabilitation of persons with disabilities
• Equalization of opportunities
• Social inclusion and participation
• Improvement in quality of life of persons with disabilities and their families

Need for CBR

1. Improves access to rehabilitation
   • Many persons with disabilities live far from hospitals and specialist rehabilitation centres.
   • CBR brings basic rehabilitation, follow-up, assistive devices, and referral support nearer to the home.
2. Makes rehabilitation affordable and practical
   • It uses local resources, family participation, community workers, and existing health, education, and welfare services.
   • This reduces travel costs and dependence on costly institutional care.
3. Promotes early identification and intervention
   • Community workers can identify disability early, refer appropriately, encourage treatment, and prevent secondary complications or worsening disability.
4. Involves the family
   • Family members can be taught home-based exercises, self-care, communication methods, mobility support, and ways to promote independence.
5. Addresses needs beyond medical treatment
   • Disability may cause school exclusion, unemployment, poverty, social isolation, and stigma.
   • CBR links rehabilitation with education, skill training, employment, social protection, and community life.
6. Reduces stigma and discrimination
   • Community awareness helps change negative attitudes toward persons with disabilities.
   • It encourages acceptance, participation, dignity, and equal rights.
7. Encourages independence and participation
   • The aim is not merely to treat impairment, but to enable people to participate in family, school, work, recreation, and public decision-making.
8. Supports inclusive community development
   • CBR helps ensure that mainstream development programmes include persons with disabilities rather than keeping disability services separate.

WHO Model of CBR: The CBR Matrix

1. Health component

• Health promotion: Nutrition, exercise, hygiene, healthy lifestyle, and awareness.
• Prevention: Immunization, antenatal care, prevention of accidents, early detection of disease and disability.
• Medical care: Diagnosis, treatment, surgery, medicines, and referral services.
• Rehabilitation: Physiotherapy, occupational therapy, speech therapy, psychological support, and home-based rehabilitation.
• Assistive devices: Provision, fitting, maintenance, and training in use of wheelchairs, crutches, hearing aids, spectacles, prostheses, orthoses, etc.

2. Education component

• Early childhood: Early stimulation, preschool support, and early intervention.
• Primary education: Admission and support in inclusive primary schools.
• Secondary and higher education: Equal opportunity for continued schooling, college, and professional education.
• Non-formal education: Functional literacy, bridge courses, and community learning.
• Lifelong learning: Continuing education and opportunities to acquire new knowledge and skills throughout life.

3. Livelihood component

• Skills development: Vocational training, apprenticeships, and work-related skills.
• Self-employment: Small businesses, cooperatives, home-based work, and entrepreneurship.
• Wage employment: Equal access to jobs, reasonable workplace accommodation, and protection from discrimination.
• Financial services: Savings groups, loans, microcredit, insurance, and banking access.
• Social protection: Disability pension, income support, scholarships, employment benefits, and other welfare schemes.

4. Social component

• Personal assistance: Support for daily living, mobility, communication, and independent living.
• Relationships, marriage, and family: Respect for personal choices, family life, parenting, and protection from abuse.
• Culture and arts: Participation in cultural events and artistic expression.
• Recreation, leisure, and sports: Equal access to games, physical activity, and community recreation.
• Access to justice: Legal protection, access to courts, protection from discrimination, and awareness of rights.

5. Empowerment component

• Advocacy and communication: Awareness of disability rights and communication of needs to the community and authorities.
• Community mobilization: Involving community members in removing barriers and supporting inclusion.
• Political participation: Participation in local governance, public policy, and elections.
• Self-help groups: Mutual support groups of persons with disabilities and families.
• Organizations of persons with disabilities (DPOs): Collective representation and advocacy for rights, services, and inclusion.

Key message