AIFO and CBR

Community Based Rehabilitation [CBR] is a strategy within community development for rehabilitation, equalization of opportunities and social inclusion of all persons with disability. It is a multi sectoral, dimensional and disciplinary approach carried out with combined efforts of persons with disability, their family members and community. It is one of the best options for the developing countries owing to its principles. They include wider coverage, community involvement, social inclusion, empowerment and human rights promotion, advocacy and sustainability, resource mobilisation, community organisation  which are the basic principles of community based rehabilitation program.

EMPOWERMENT OF PERSONS WITH DISABILITIES

Do you want to know how AIFO promotes empowerment of persons with disabilities?

Disparity among the human beings is a grim reality of the civil society. Human beings are often discriminated on the grounds of age, sex, wealth, power, caste, creed, race, and religion, physical and mental abilities. Persons with disabilities are one such under privileged group whose rights are profoundly violated since ages. This page attempts to draw your attention towards the issues, rehabilitative needs addressed at the community level by AIFO and its partners through inclusive developmental approaches.

A number of factors attribute to disability. Most of the disability programs suffer from the lack of disability data and the conceptual clarity. Mostly lack of uniform definition of disability, inadequate methodologies, lack of trained human resource, lack of political will, and absence of priority to the issue, inadequate technology, so on and so forth.

Recalling the historical developments, many attempts have been made to provide a productive life to persons with disability since long in different ways by Governments, INGOs and NGOs. This kind of process of promoting changes with in individual towards better quality of life of persons with disability is generally called rehabilitation. The stages of rehabilitation of persons with disability include home, charity, medical rehabilitation, socio economic, empowerment, inclusive/human rights promotion through various community based rehabilitation approaches.

The concept of Community Based Rehabilitation (CBR) programme arose with Alma Ata Declaration of 1978 by the heads of various ministries of health throughout the world.  It became a parental umbrella for different kinds of rehabilitation programmes, to facilitate rehabilitation services with a base at the level of the community.

Subsequent to that particular declaration the Community Based Rehabilitation (CBR) programme of the World Health Organization was officially launched in 1981, which was also celebrated as international Year of the Disabled. The concept of CBR is involved in all those measures taken at community level, in order to   rehabilitate the disabled and to build on the resources of the community. Further, UNICEF began active support of CBR programmes in the poorest of the countries in the beginning of the 1980’s. These have concentrated on disabled children but   all the principles were linked to the   general child health services. Since the poor countries had limited resources to provide high quality institutional services, the emphasis was on developing a method, which provided wide coverage, at costs that were affordable to the governments of these countries. In CBR, interventions were to be shifted from institutions to the homes and communities of persons with disabilities, and carried out by minimally trained people, such as families and other community members, thereby reducing the financial costs (WHO, 1989). In the early eighties, CBR was conceptualized and evolved primarily as a service delivery method with a medical focus. WHO recommends that it be integrated into the primary health care (PHC) system that was already well established in many developing countries.

Protection of the rights of persons with disabilities, and empowerment of the community to manage their programmes are other aspects of As the CBR started scattering across developing nations, there were also major changes in the way it was conceptualised (Thomas and Thomas, 1999). One of the early changes was the shift from a medical focus to a more comprehensive approach. With the realisation that stand alone medical interventions did not complete the rehabilitation process, CBR programmes gradually began to add on interventions such as education, vocational training, social rehabilitation and prevention. Along with this came the recognition that CBR needed to deal with issues relating to persons with disabilities’ lives at all times, and to change not only the disabled individual, but the context in which he or she was located. Changing contextual factors involves helping non-disabled people in the community accept persons with disabilities, promote their social integration, and equalize their opportunities to access education and employment, in the same way as non-disabled people.

the contextual changes  require involvement from the community, both before, during and after the formal programme phase if a philosophy of sustainability is to be embraced. Thus, CBR today, follows a social, rather than an exclusively medical model, but there are still many questions to be answered before CBR can be implemented effectively. It may need two or three more generations before CBR becomes part of the established culture and therefore sustainable. The following discussion deals with the some of the questions that need to be addressed with regard to the inclusion of persons with disability due to leprosy.

It is quite tough task to  provide a comprehensive definition for Community Based Rehabilitation (CBR).  Different organizations, agencies and other experts define CBR in different ways.  Experience of these experts has changed the meaning of CBR.  Since many years it is practiced at different levels. There are numerous deliberations have taken place among the international agencies based on their field experiences like UNO, ILO, WHO, UNDP IDDC, number of DPOs and other individual experts in the area. This process created an impact on the whole approach of CBR, which resulted in different models of rehabilitation services and WHO came out with CBR training manuals in the year 1989.

It is not the definition or the concept of rehabilitation or CBR is important, but to have a right perspective, approach, model, broader understanding of disability and inclusive development as conceptualized in article 3 of the United Nation Convention on the Rights of Persons with Disability (UNCRPD) and the new CBR guideline published by WHO and other UN agencies in October 2010 (supplementary chapter on leprosy). This process requires a comprehensive, relevant, empowering, social inclusion, strategy, right perspective and   holistic approach to the issue of inclusive development for not just persons affected by leprosy but for all kinds of people with disability in the society. Eventually persons affected by leprosy weather with disability or without disability will also enjoy equality of rights, dignity, respect and part of the inclusive development in the society.

CBR methodology focusing on transfer of knowledge and skills to PWDs, their families, and communities with the purpose to reduce the impact of disability for a person, enabling him or her to achieve independence, social inclusion, a better quality of life and self-actualization. Extension of these programs through earlier rehabilitation methods to all rural areas is difficult which requires huge amount of human resources, funds and materials. In such a case, the CBR methodology provides an effective alternative for providing essential services and extension of rehabilitation services to the rural, semi urban and other remote areas. In many countries the local NGOs practiced CBR methodology and organizing persons with disability into disabled person’s organizations to support a productive life for people with disability. When compared to Institutional Based Rehabilitation the CBR approach permits coverage of large number of people, is cost effective, favours the community participation and PWDs social inclusion. At the end, it becomes a collective effort for achieving the common goal of facilitating a productive life for these unprivileged sections of the society.

AIFO decided to apply such principles in the leprosy projects, through capacity building activities and exchange visits by various partner organizations. Such an initiative was promoted by AIFO in the year 1993 during its biannual meeting at Cochin. At the same time, the relevance of CBR in the changing scenario of leprosy program was discussed and strategies were spelt out to strengthen CBR concept. It was felt that, it is appropriate that all the projects supported by AIFO in India will incorporate the leprosy-related activities through CBR principles. Further, new initiatives were identified where these principles are effectively implemented.

Through our Community Based Rehabilitation projects….