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Community Based Rehabilitation, an Urban
Experience
Why CBR?
Institutional
Rehabilitation provides excellent services to address the problems of
individual disabled persons and is often available only for a small number at
a very high cost. Institutional overheads and other major
infrastructural expenses make the process very expensive.
Moreover, the endeavours in an institution are often out of context to the
felt needs of the disabled person, and thus falls short of their
expectations. The fact that this person comes from a particular
background and cultural setting is often ignored. The
institutional culture is imposed on the disabled person and they are often
expected to function as advised by the “experts”. In an
institutional rehabilitation programme, the community is not linked with the
process. Hence, when the disabled persons return home, it may become
difficult for them to integrate into their community.
Many
institutions follow community-oriented approaches. In this method of
approach, the services are provided at the level of community through an
outreach clinic or camp based approach. The programme is guided by the
institution and directed by the availability of the resources. The
patients and community are only the beneficiaries. e.g. as and when appliances like wheelchair, tricycle, or calipers become available, they get distributed whether
it is appropriate or not. However, these strategies are inadequate to
respond to the needs and expectations of the disabled and their
community. Rehabilitation based in the community ensures community
participation, uses locally available resources and learns from existing
innovative approaches in the community.
The
general estimate is that approximately 10% of any population is disabled.
Among them 70% of the problems related to disability could be addressed in
the community itself, usually with locally available resources. Community
Based Rehabilitation is defined as a strategy within community development,
for rehabilitation, equalization of opportunities and social integraton of all people with disabilities. Community
Based Rehabilitation is implemented through the combined efforts of the
disabled people themselves, their families and communities along with medical
and other experts as appropriate, incorporating health education, vocational
and social services (ILO, UNESCO & WHO, 1994, Community Based
Rehabilitation – For and with people with disabilities – a joint position
paper).
Accomplishing
this involves creation of awareness in the community regarding disability,
value of disability prevention, and rehabilitation methods. In order to
base the rehabilitation in the community it is of prime importance to inspire
the community and recruit volunteers for this task. This is not an easy
process. Absolute altruism is against the basic principle of
biological evolution, a fact which needs to be considered, whereas recruiting
people for a remuneration will often lead to
building up a group of people who are more interested in perks than the
task. A healthy mix of altruism combined with practicality is a crucial
ingredient in community-based rehabilitation. An education and training model
was found to be a compromise approach, which is likely to succeed, as will be
explained subsequently. The volunteers need to be trained to identify and
intervene appropriately to deliver rehabilitation services in the community.
As
Volunteers gain expertise in managing 70% of disability problems, they will
also encounter 30% of the difficult problems related to disability, which
they are not able to deal with and solve within the community. The
relevance of secondary and tertiary care centers,
which are linked to CBR, therefore becomes quite crucial at this
juncture. These links help the CBR workers (local volunteers) to deal
with difficult problems, learn from them, and thereby become confident in the
whole process of CBR through their interactions with disabled people,
families and community as well as trainers from secondary and tertiary centers. Thus, a CBR set-up established in the community
comprising of local people, who are supported by secondary and tertiary centers for help as and when difficulties are encountered,
is an effective approach, which maintains and sustains the process of
CBR. These interactions between the local community and the secondary
and tertiary centers are mutually beneficial.
The secondary and tertiary care centers get a feel
for the ground realities, and the community gets the benefit of the knowledge
and expertise of these centers. Together they can
then evolve solutions that are relevant and appropriate for the
community. In addition, linking with the schools, other community developmental
programmes, Government Organizations and Non Government Organizations will
further enrich the CBR programme and facilitate long-term sustainability.
It
is often debated whether CBR should follow a medical or social model.
Issues concerning health and society are deeply interlinked and inseparable,
and attempts to delink or compartmentalise these
interwoven aspects will be unnatural and artificial. Therefore,
solutions mooted from polarized viewpoints are likely to be unsuccessful in
the long run. In this project we used an ‘educative model’. Thisincluded both medical and social aspects of
rehabilitation. It generated skill and expertise for development and
rehabilitation, which can be available always in the local community.
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Foreword Community
Based Rehabilitation Why
CBR? How
we did CBR? Activities Methodology Lessons
from the field Evaluation Sustainability Acknowledgement Contact
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