Community-Based Rehabilitation: Empowering Inclusive Development
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Bishkek, 29-30 October 2018.
I
T
I
S
K
N
O
W
N
T
H
A
T
•
According to expert estimates, at least
10% of people
worldwide have
disabilities.
•
2.5-3% of people
who live near us
have some kind of disability or
limitation and could benefit from
rehabilitation.
•
Usually, rehabilitation centres, sanatoriums and hospitals are located
in
large cities
; it is difficult to get there and many people with disabilities cannot
get regular or complete assistance there.
I
t
i
s
e
s
t
i
m
a
t
e
d
t
h
a
t
n
o
m
o
r
e
t
h
a
n
2
-
3
%
o
f
p
e
o
p
l
e
w
h
o
c
o
u
l
d
b
e
n
e
f
i
t
f
r
o
m
r
e
h
a
b
i
l
i
t
a
t
i
o
n
r
e
c
e
i
v
e
t
h
e
c
o
r
r
e
c
t
l
e
v
e
l
o
f
r
e
h
a
b
i
l
i
t
a
t
i
o
n
!
•
We
lack, and will for a long time continue to lack,
trained staff for rehabilitation facilities.
•
The construction, equipping and maintenance of
institutions, and payments to employees, are
very
expensive
, especially if highly professional staff
are used.
•
It’s
impossible to
build centres in every
town/village
This means that we need to build more centres and
hospitals! ...
In some countries, it will take more than
100 years
to solve the problem of helping
people with disabilities by establishing new
specialized institutions or mobile services
and training highly qualified personnel!
People with disabilities
experience many
difficulties in everyday life
;
They and their loved ones
don't know
how to handle
eating, feeding, dressing, washing etc.
Specialists from rehabilitation centres
do not teach,
they merely treat
...
And one more problem
•
In 1978
, the World Health Organisation (WHO)
introduced the concept of CBR following the
International Conference on Primary Health Care
and the
Alma-Ata Declaration
.
•
CBR was initially seen as a
strategy for improving
access
to rehabilitation services for people with
disabilities in developing countries.
•
Over the next 30 years, however, it has expanded
significantly and has now become a
strategy for
inclusive community development
.
The Community-Based Rehabilitation Strategy
COMMUNITY BASED REHABILITATION
(CBR)
•
A rehabilitation programme
that is as
close
as possible to
the service users
•
Programme aimed at maximizing use of
local resources
•
A programme aimed at
increasing the skills of
persons with
disabilities as well as their families and other community
members
Since 1989, it has been translated into
more than 50 languages!
•
3
0
t
r
a
i
n
i
n
g
p
a
c
k
a
g
e
s
f
o
r
p
e
o
p
l
e
w
h
o
:
•
are visually impaired
•
are deaf
•
have limited mobility
•
have impaired sensitivity
•
have behavioural problems
•
suffer with fits
•
have learning disabilities
•
General packages
•
G
u
i
d
e
l
i
n
e
s
•
for the Local Rehabilitation Committee
•
for the Coordinator
•
for teachers
•
for people with disabilities
•
for families of people with disabilities
Methodological support
•
Training
people with
disabilities
their loved ones
other people living nearby
•
Searching for solutions
how to organize support
how to make a difference in these people's
lives
what resources can be used
Learning in society
•
10% of the world's population
, that is 650 million people, are
living with disabilities
•
80% of
people with disabilities live in
developing countries
•
15-20% of
the world's
poorest
people are disabled
•
Only 5-15% of
persons with disabilities in developing
countries have access to means of assistance
•
80% of
disabled people of working age are unemployed
•
1-2% of children
with disabilities in developing countries have
access to education (UNESCO)
•
Only 1% of
girls with disabilities in developing countries can
read and write (UNICEF)
World Statistics on Disabled People
•
Community Based Rehabilitation (CBR
) is a strategy
implemented within the overall framework of community
development aimed at providing rehabilitation and equal
opportunities, eradicating poverty and including people with
disabilities in society
.
(International Consultation on
Community Rehabilitation, Helsinki, 2003)
•
Later, Member States were called on to
"develop and
strengthen community-based rehabilitation programmes..."
(
World Health Assembly
Resolution 58.23
on Disability
Prevention and Rehabilitation, 2005)
•
CBR plans are currently being implemented
in over 100
countries.
New definition of CBR
Orientations of the CBR program (Helsinki, 2003)
•
Reducing poverty
, given that poverty is a key factor in, and a
result of, disability.
•
Promotion of
community participation
in the design and
implementation of CBR programmes and recognition of
community ownership of the results of this work.
•
Developing and strengthening
multi-sectoral collaboration
.
•
Involving
organizations of persons with disabilities
in the
programmes.
•
Scaling
up the implementation of CBR programmes.
•
Promotion of best practices
on the basis of evidence.
•
Poverty must be eliminated
, because it is both a
cause and a consequence of disability. The poor are
more likely to become disabled, and the disabled
are more likely to become poor.
•
Addressing disability issues is a specific step
towards reducing poverty in any country.
•
At the same time, addressing poverty issues helps
reduce disability.
EXAMPLES
CBR for 25 years - Poverty and Disability (Helsinki,
2003)
Disability and poverty
•
Development is inclusive if it
reaches and engages all
,
especially groups that are marginalized and often
discriminated against
•
Facilitates participation by communities
(local
communities), including persons with disabilities, in the
design and implementation of CBR programmes to
enable persons with disabilities to
contribute
to the
creation of new development opportunities, benefit
from development and participate in decision-making
WHAT DOES THIS MEAN?
CBR for 25 years - Inclusive Community Development
(Helsinki, 2003)
Inclusive - an "inclusive" society or a "society
for all"
The principle of "inclusion" guides policies for:
•
Inclusive (included) education
•
Inclusion of disability issues into health care
•
into vocational education and work
•
inclusion of people with disabilities in life in general (culture,
recreation, leisure etc)
"Included" society means first and foremost
that
society will change itself
,
and its structures and procedures,
rather than expecting change
from people with disabilities
•
On 13 December 2006, the UN General Assembly
adopted the
Convention on the Rights of Persons
with Disabilities
, which calls for full and equal
enjoyment by all persons with disabilities of all
human rights and fundamental freedoms.
•
Involving organizations for persons with disabilities
in the programme
WHY?
EXAMPLES WHERE IT WAS REALLY NEEDED
CBR over 25 years - a human-rights-based
approach to development (Helsinki, 2003)
Disability and human rights
•
CBR gives people with disabilities the right to live
as equal citizens of their country, to enjoy health
and emotional well-being, and to participate fully
in educational, social, cultural, economic and
political affairs.
•
CBR emphasizes that
girls and boys
with disabilities
have equal rights in school, and
men and women
have equal rights and opportunities in professional
and social activities.
•
In 2004, a
RMA matrix
was developed to provide
the structural framework for RMA programmes
•
The first four components relate to
key
development sectors
, reflecting the multi-sectoral
nature of CBR.
•
The fifth component relates to the
empowerment
of persons with disabilities
WHY?
CBR over 25 years - A Multi-Spectral Community
Development Strategy (Helsinki, 2003)
CBR: MZ+MTSZ+MO+MA+NPO
H
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CBR
Empowerment
T
O
H
E
H
L
T
H
S
o
c
i
a
l
R
e
h
a
b
i
l
i
t
t
a
t
i
o
n
L
i
v
e
l
i
h
o
o
d
E
D
U
C
A
T
I
O
N
•
Scaling up the implementation of the programme
•
Promoting best practices on the basis of
evidence
CBR over 25 years (Helsinki, 2003)
Caritas Germany CBR projects
Projects funded by Caritas Germany, the European Union
and the German Federal Ministry for Economic Cooperation
and Development (BMZ)
Caritas Germany CBR projects
Projects funded by Caritas Germany, the European Union
and the German Federal Ministry for Economic Cooperation
and Development (BMZ)
Community-Based Rehabilitation (CBR) is a strategy that originated in 1978 as a means to enhance access to rehabilitation services for individuals with disabilities in developing nations. Over the years, CBR has evolved into a holistic approach for fostering inclusive community development. By decentralizing services and utilizing local resources, CBR aims to address the challenges faced by people with disabilities in their daily lives. This strategy not only bridges the gap in access to professional rehabilitation but also empowers individuals and communities to support each other towards a more inclusive society.
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SESSION 1.1. COMMUNITY-BASED REHABILITATION (CBR). HISTORY AND RELEVANCE Munavvarova Umeda, RUO Programme Coordinator, Tajikistan Branch of Caritas Germany The presentations were prepared on the basis of materials by E. Klochkova and L. Samarina, international consultants on CBR, physical therapy and early intervention Bishkek, 29-30 October 2018.
IT IS KNOWN THAT According to expert estimates, at least 10% of people worldwide have disabilities. 2.5-3% of peoplewho live near us have some kind of disability or limitation and could benefit from rehabilitation. Usually, rehabilitation centres, sanatoriums and hospitals are located in large cities; it is difficult to get there and many people with disabilities cannot get regular or complete assistance there. It is estimated that no more than 2-3% of people who could benefit from rehabilitation receive the correct level of rehabilitation!
This means that we need to build more centres and hospitals! ... We lack, and will for a long time continue to lack, trained staff for rehabilitation facilities. The construction, equipping and maintenance of institutions, and payments to employees, are very expensive, especially if highly professional staff are used. It s impossible to build centres in every town/village
In some countries, it will take more than 100 years to solve the problem of helping people with disabilities by establishing new specialized institutions or mobile services and training highly qualified personnel!
And one more problem People with disabilities experience many difficulties in everyday life; They and their loved ones don't know how to handle eating, feeding, dressing, washing etc. Specialists from rehabilitation centres do not teach, they merely treat...
The Community-Based Rehabilitation Strategy In 1978 , the World Health Organisation (WHO) introduced the concept of CBR following the International Conference on Primary Health Care and the Alma-Ata Declaration. CBR was initially seen as a strategy for improving access to rehabilitation services for people with disabilities in developing countries. Over the next 30 years, however, it has expanded significantly and has now become a strategy for inclusive community development.
COMMUNITY BASED REHABILITATION (CBR) A rehabilitation programme that is as close as possible to the service users Programme aimed at maximizing use of local resources A programme aimed at increasing the skills of persons with disabilities as well as their families and other community members
Since 1989, it has been translated into more than 50 languages! 30 training packages for people who: are visually impaired are deaf have limited mobility have impaired sensitivity have behavioural problems suffer with fits have learning disabilities General packages Guidelines for the Local Rehabilitation Committee for the Coordinator for teachers for people with disabilities for families of people with disabilities
Learning in society Training people with disabilities their loved ones other people living nearby Searching for solutions how to organize support how to make a difference in these people's lives what resources can be used
World Statistics on Disabled People 10% of the world's population , that is 650 million people, are living with disabilities 80% of people with disabilities live in developing countries 15-20% of the world'spoorest people are disabled Only 5-15% of persons with disabilities in developing countries have access to means of assistance 80% of disabled people of working age are unemployed 1-2% of children with disabilities in developing countries have access to education (UNESCO) Only 1% of girls with disabilities in developing countries can read and write (UNICEF)
New definition of CBR Community Based Rehabilitation (CBR) is a strategy implemented within the overall framework of community development aimed at providing rehabilitation and equal opportunities, eradicating poverty and including people with disabilities in society. (International Consultation on Community Rehabilitation, Helsinki, 2003) Later, Member States were called on to "develop and strengthen community-based rehabilitation programmes..." ( World Health AssemblyResolution 58.23 on Disability Prevention and Rehabilitation, 2005) CBR plans are currently being implemented in over 100 countries.
Orientations of the CBR program (Helsinki, 2003) Reducing poverty, given that poverty is a key factor in, and a result of, disability. Promotion of community participation in the design and implementation of CBR programmes and recognition of community ownership of the results of this work. Developing and strengthening multi-sectoral collaboration. Involving organizations of persons with disabilities in the programmes. Scaling up the implementation of CBR programmes. Promotion of best practiceson the basis of evidence.
CBR for 25 years - Poverty and Disability (Helsinki, 2003) Poverty must be eliminated, because it is both a cause and a consequence of disability. The poor are more likely to become disabled, and the disabled are more likely to become poor. Addressing disability issues is a specific step towards reducing poverty in any country. At the same time, addressing poverty issues helps reduce disability. EXAMPLES
Disability and poverty Poverty No job Poor nutrition No skills Poor health No education Disability
CBR for 25 years - Inclusive Community Development (Helsinki, 2003) Development is inclusive if it reaches and engages all, especially groups that are marginalized and often discriminated against Facilitates participation by communities (local communities), including persons with disabilities, in the design and implementation of CBR programmes to enable persons with disabilities to contribute to the creation of new development opportunities, benefit from development and participate in decision-making WHAT DOES THIS MEAN?
Inclusive - an "inclusive" society or a "society for all" The principle of "inclusion" guides policies for: Inclusive (included) education Inclusion of disability issues into health care into vocational education and work inclusion of people with disabilities in life in general (culture, recreation, leisure etc) "Included" society means first and foremost that society will change itself, and its structures and procedures, rather than expecting change from people with disabilities
CBR over 25 years - a human-rights-based approach to development (Helsinki, 2003) On 13 December 2006, the UN General Assembly adopted the Convention on the Rights of Persons with Disabilities, which calls for full and equal enjoyment by all persons with disabilities of all human rights and fundamental freedoms. Involving organizations for persons with disabilities in the programme WHY? EXAMPLES WHERE IT WAS REALLY NEEDED
Disability and human rights CBR gives people with disabilities the right to live as equal citizens of their country, to enjoy health and emotional well-being, and to participate fully in educational, social, cultural, economic and political affairs. CBR emphasizes that girls and boys with disabilities have equal rights in school, and men and women have equal rights and opportunities in professional and social activities.
CBR over 25 years - A Multi-Spectral Community Development Strategy (Helsinki, 2003) In 2004, a RMA matrix was developed to provide the structural framework for RMA programmes The first four components relate to key development sectors, reflecting the multi-sectoral nature of CBR. The fifth component relates to the empowerment of persons with disabilities WHY?
CBR: MZ+MTSZ+MO+MA+NPO CBR ED r e h a b i l i t Social Re S o c i a l E d u c a t i o n T a t i o n L i v e l i h o o d hab O UC Li H e a l t h il H A ve it E T li ta H I ho ti L O od on T N H Empowerment
CBR MATRIX EDUCATION HEALTH LIVELIHOOD - means of survival SOCIAL - social rehabilitation Empowerment - expanding capabilities Skills Personal assistance Advocacy and communication Promotion and propaganda Development in early childhood development Primary education Self- Relationship, marriage, family Community mobilization Prevention Employment Culture and arts Political participation Wages Medical care and attention Secondary and higher education Employment - a job with a salary Financial services Self-help groups Non-formal learning Recreation, leisure and sports Rehabilitation Social Protection Disabled people's organisations Assistance Devices Lifelong learning Justice
CBR over 25 years (Helsinki, 2003) Scaling up the implementation of the programme Promoting best practices on the basis of evidence
Caritas Germany CBR projects Vahdat (2010-2017) Devastich (2012-2017) Konibodom (2012-2017) Shahrituz (2017-2020) Aini (2018-2020) Projects funded by Caritas Germany, the European Union and the German Federal Ministry for Economic Cooperation and Development (BMZ)
Caritas Germany CBR projects Projects funded by Caritas Germany, the European Union and the German Federal Ministry for Economic Cooperation and Development (BMZ)
