|Sustainable Development and Persons with Disabilities: The Process of Self-Empowerment (ADF, 1995, 117 p.)|
|Section I: Understanding and perception|
|Chapter 4: Community-based rehabilitation|
CBR is an approach of rehabilitation, equalization of opportunities, and social integration of all people with disabilities within community development. It is implemented, using locally available resources, through the combined efforts of the disabled people themselves, their families and communities, and the appropriate health, education, vocational and other social services.
Let us break this broad definition into specific goals.
What do we want to achieve in CBR?
We want to achieve:
· The full social integration of persons with disabilities within their communities;
· Disability prevention in Primary Health Care (PHC) activities, and rehabilitation to minimise the disabling conditions and barriers;
· The integration of disabled children into mainstream schools,
· The removal of social, institutional and attitudinal barriers to the opportunities for gainful economic activities for PWDs; and, all this leading to the self-realisation and self-empowerment of PWDs.
How do we go about it?
It is, essentially, a participatory approach in which persons with disabilities working within their communities develop their own strategies to enable them to fully participate in the mainstream of community life by:
· building their self-confidence;
· promoting horizontal, multi-sectoral coordination and cooperation;
· using locally available resources (material and human);
· developing a positive attitude among both able bodied and people with disabilities towards one another through sensitization programmes;
· providing information and raising awareness about disability issues to the communities;
· demonstrating the abilities, skills and contributions of PWDs;
· providing appropriate aids and equipment; and
· equalising opportunities of access to education, health, skills training, employment, recreation, social and cultural life.
These are broad guidelines. They may not apply to all situations and in all circumstances. Much depends on the communities themselves:
· their location (whether rural or urban);
· their cultural, religious and traditional heritage;
· the availability of local resources;
· the degree of unity within the community;
· the skill and wisdom of community leadership, including those who can provide leadership from among the disabled people themselves;
· the type of disability that predominates in the community (for example, river blindness); and so on.
There is no one ideal model.
Various Models of CBR
Community Rehabilitation Village (CRV)
Community Integrated Program (CIP)
Neighbourhood Day Centres (NDC)
Outreach Mobile Team (OMT)
Family-Based Rehabilitation Program (FRP) Outreach
Mawotto's ferry boats. (Photo by Thad Kaminski)
Given the diversity of the above factors, all kinds of combinations are possible. For example, a village steeped in the Islamic tradition would have one approach to CBR compared to another where mixed religions and mixed cultures coexist. Below are some possible models or scenarios that might apply to some situations but not to others. Again, we place it in a continuum showing there are no walls that separate one model from another, and that each approach could start with one model and move into another.
The continuum has on its left the most comprehensive approach - Community Rehabilitation Village (CRV) where the whole village or community is involved in the rehabilitation process. At the extreme right then, we have a family based rehabilitation programme (FRP) with some outreach support from outside. In between are some intermediate approaches.
The Community Integrated Programme (CIP) is a variation of the CRV whereby the PWDs and the able-bodied in a community are collectively involved in a joint project, for example, a communal garden to ensure village food security and storage.
The Neighbourhood Day Centre (NDC) rings together people with different disabilities, and sometimes carets, to a common location within the community to work, counsel each other, gossip and rejoice together. The important thing is that they go back to their respective families and thus are not isolated.
The Outreach Mobile Team (OMT) is a rehabilitation outreach programme whereby specialist staff from a nearby institution such as hospital or school visit individual homes, day centres or clinics.
As we said earlier, and it needs repeating, these approaches are not mutually exclusive. CRV and CIP can go together. CIP and FRP can go together. And the OMT can apply to all situations. What models or combinations are designed entirely depends on the people themselves using the "participatory" approach, and the circumstances of each situation.
We must repeat that there is no "ideal model", and the attempt to create one will turn it into yet another "institutional structure." However, it is important that for purposes of sustainability, whatever approach is adopted, it has the backing, support and involvement of the community.