Community Based Rehabilitation

CBR
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bal/david/dwe002/dwe00247.html
 Introduction
Approximately 600 million people in the world
experience disability of various types and degrees. This
represent 10% of the world population .Helandar
stated that an estimated 70% of the disabled people
live in devolving countries .He further indicate that
there were about 234 million moderately or severely
disabled people living in developing countries .
The national 2008 Sudan Census estimated the
prevalence of disability at 4.8%. It also measured the
number of children under 18 years at 15 million,
indicating that approximately 720,000 Sudanese
children have disabilities.
 The 1960s and 1970s was, for many
developing countries, an era of newly won
independence from former colonial powers.
This independence was accompanied by an
enthusiasm to provide high-standard
healthcare, education and other services for
the people.
 Governments moved to establish teaching
hospitals and medical and nursing schools,
often with the assistance of donor nations.
These tertiary services consumed the largest
portion of the country's healthcare budget,
and were available mostly in urban areas,
creating access problems for the
predominantly rural societies.
 Healthcare services to the rural majority were
supplied by missionary hospitals and clinics, or
by "touring services" provided from urban
hospitals. There was a wide variety of services
of varying standard and quality in the rural
areas. Most of the population still visited
traditional healers.
 In the 1960s and 1970s, China, Tanzania,
Sudan and Venezuela initiated successful
programs to deliver a basic but
comprehensive program of primary care
health services covering poor rural
populations. .
 From these programs came the name
"primary health care". Papua New Guinea had
a similar comprehensive program in place for
some years. This new methodology for
healthcare service delivery incorporated a
questioning of top-down approaches and the
role of the medical profession in healthcare
provision
 During the 1970s, a synthesis of these
concepts was undertaken by the World Health
Organization (WHO) and UNICEF. It addressed
the need for a fundamental change in the
delivery of healthcare services in developing
countries, with an emphasis on equity and
access at affordable cost, and emphasising
prevention while still providing appropriate
curative services
 The Declaration of Alma Ata
The Foundations of Primary Health Care:
The Declaration of Alma-Ata formally adopted
primary health care (PHC) as the means for
providing a comprehensive, universal,
equitable and affordable healthcare service
for all countries. It was adopted by all WHO
member countries at Alma-Ata in the former
Kazakh Soviet Republic in September 1978
 Primary health care is essential health care
based on practical, scientifically sound and
socially acceptable methods and technology
made universally accessible to individuals and
families in the community through their full
participation and at a cost the community and
country can afford to maintain at every stage
of their development in the spirit of self-
reliance and self-determination..
 It forms an integral part both of the country's
health system, of which it is the central function
and main focus, and of the overall social and
economic development of the community. It is the
first level of contact of individuals, the family and
community with the national health system
bringing health care as close as possible to where
people live and work, and constitutes the first
element of a continuing health care process
Alma Ata Declaration, 1978
 Community Based Rehabilitation (CBR) began
as an idea. People worked with this idea in
different ways, so that 'CBR' now means many
things.
 Disability in Villages & Small Towns
To look at the idea of CBR, we must go back in
history. In most times in the past, people lived
in villages and small towns. They did not have
hospitals or schools. Whatever they needed to
learn, they learnt from their mothers and
fathers and older family members. If people
had a physical or mental disability, their
families and neighbours tried to help them.
 For example, a child might lead a blind person
around the village. Grandmother spent extra
time at home teaching a child with a mental
disability to talk. The men in the family made
a wooden crutch to help a lame person walk.
One of the neighbours learnt to talk with deaf
people who make signs using their hands.
 . Disabled people found some work to do in the
fields or at home that suited their abilities.
People with mental disabilities were given jobs
that they could learn easily. People whose
disability stopped them from doing ordinary work
found something else to do, like fortune-telling or
massage or music. When disabled people had no
family to help them, and could not earn enough
to live on, they begged food and shelter from
other people in the village or town.
 . Even if everyone helped, it was still a hard life for
disabled people. There were things you wanted to do,
but could not do. You might get less to eat than other
people, especially if you were a girl or woman. There
were problems about finding a wife or husband for
you. And even if other people helped, they might also
sometimes tease you or be cruel. Sometimes they said
you had a strange 'spirit' in you, which made you
disabled. But you made the best you could of your life.
You learnt how to find your way around, and how to
deal with other people in your village or small town.
You had a place there, even if it was not a very good
place.
 . Even if everyone helped, it was still a hard life for
disabled people. There were things you wanted to do,
but could not do. You might get less to eat than other
people, especially if you were a girl or woman. There
were problems about finding a wife or husband for
you. And even if other people helped, they might also
sometimes tease you or be cruel. Sometimes they said
you had a strange 'spirit' in you, which made you
disabled. But you made the best you could of your life.
You learnt how to find your way around, and how to
deal with other people in your village or small town.
You had a place there, even if it was not a very good
place.
 Disability in the City
The Best of Both
. For many people in the world now, it is still a big problem to get help for
their disability. City institutions are far away and cost too much. Even if
you go to one, the help you get there may not be right for your home and
family in the village, or in the poor part of the city. Some people ask, Why
can't we have the best of both? Why don't we get the knowledge from
specialists, and let people have it in the villages and towns where poor
people live?
This is a big question. And people ask more questions. Some ask, Why are
disabled people always poor? Why do they get less education than other
people? Some disabled people say, We have a right to live like anybody
else, and to have our share of good things. We should not be looked down
on, or called by names that put us down. Some people say, Disabled boys
and men get help, but disabled women and girls get none. They say, Our
disability would not be a problem, if houses and streets and schools were
built so as to make it easier for us
 Definition
Community based rehabilitation (CBR) is a
strategy within general community
development for rehabilitation, equalization
of opportunities and social inclusion of all
children and adults with disabilities and
implemented through the combined effort of
persons with disabilities, and the appropriate
health, education, vocational and social
services
 . Now we get to CBR. The idea of CBR is that
disabled people should have the right to a good
life. The help they need should be available to
them, at a low cost. It should be offered to them
and their family in a way that suits their usual
way of living, whether in a village, a town or a
city. They should have education like everybody
else. They should be able to take up jobs and
earn their living. They should be able to take a full
part in all the activities of their village, or town or
city.
 The idea of CBR is that, even if people learn
very slowly, or have problems seeing or
hearing, or find it hard to move about, they
should still be respected for being men and
women, girls and boys. Nobody should be
looked down on, or treated badly just because
they have a disability. Houses, shops and
schools should be built in such a way that
everyone can easily go in and out and make
use of them.
 Information should be given to people in a way
they understand, not only in writing, which is
hard for people who cannot read or have
problems seeing it. Information should be given
in spoken forms as well, so that everyone has a
fair chance to use it. To do all this would mean a
lot of changes. But they would be good changes,
because everyone could live a better life, helping
each other and respecting one another.