Innovations in Community Based Rehabilitation

National Seminar on ˜Innovations in CBR" organised by CBR Forum

 12 Mar 2005

Text of the Key Note Address “ C Mahesh, Mobility India

Good morning,

Firstly I would like to thank CBR Forum for providing me this great honour of delivering the key note address.

I am here not as an expert, but I am here to share what I have experienced and learnt in the field of CBR and I hope to learn more from your experiences during this seminar.

In my address today I am focusing on the evolution and the current thinking in CBR and some of the different areas for innovation in our work.

It is a well established fact that all communities are different in terrain, culture, their political systems, socio-economic conditions and many other factors.  Therefore, there cannot be one model of CBR for the whole world.  And as we are well aware, it may not be the same even within the same country. There are many models of CBR programmes, each unique to its own situation. This is the uniqueness of CBR. And at the same time the challenge of CBR programmes.

However, from experience, it has been realized that there need-to-be some basic norms for a valid CBR programme. Evidence is needed that the particular CBR strategy being used is the most effective approach to enhance the quality of life for people with disabilities and their family members. Gathering good evidence therefore is critical and a seminar like the National Seminar which is focusing on the different 'Innovations in CBR' is a significant step in this direction.

Community-based rehabilitation (CBR) was developed as a response, to the need, to reach people with disabilities at the community level.

Although, the definition, major objective, and principles of CBR have not changed since 1994, there has been an evolution of concepts in CBR.

The joint statement by ILO, UNESCO and WHO in 2002 states - ˜CBR is a strategy within general community development for rehabilitation, equalization of opportunities and social inclusion of all children and adults with disabilities".

Therefore Rehabilitation does not mean only "cure or treatment" “ it has a much deeper meaning "dignity, equal opportunities and equal rights"

CBR is essentially about human rights and the enabling of participation in the whole range of human activities.

Human Rights are often understood in a very limited way. In reality ˜rights" refers not just to the civil and political rights but also to also to the right to have basic human needs met, such as the right to life, food, shelter, staying with one's family, and the right to develop as a human being. This is particularly important in relation to disability, because the majority of disabled people are still struggling to access these very basic human rights.

For a child with cerebral palsy born into a poor community, the right to survive, develop, have sufficient food, shelter, and the opportunity to develop basic functioning and basic daily living skills must be realised. These basic rights are the foundations on which all other rights such as - the right to express their views, participate in society and access education etc stand.

Poverty is the critical issue for people with disabilities. Mainstream approaches to poverty alleviation frequently marginalize or ignore the rights of people with disabilities.

Poverty alleviation strategies which target people with disability also bring socio-economic benefits to the whole community and ultimately to the socio-economic benefits of the country.

There are many models for addressing disability “ the medical model, social model and more recently the rights based model. Like I said earlier every CBR programmes is unique and for making the maximum impact on the lives of people with disabilities, especially the poor, what we need is an approach that is a combination of all the three models taking into account the social, economic and political conditions.

It must be noted that CBR in today's world is being implemented against the backdrop of the globalization and privatization. It is also the time when the Millennium Development Goals for eradicating poverty is bearing an influence on development programme and it is also the time when the UN is drafting the ˜International Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities'.

And against this backdrop WHO and other UN agencies have already begun the task of developing a step-by-step guide to the implementation of CBR which I am going to briefly present from the draft version.

Accordingly - the principles of a CBR programme are based on -

And this where innovativeness in a CBR programme has a curtail role to play. For example “ it is common to organise disabled people's group “ but these groups in many instances are prone to die a natural death simply because the NGO or the organisation have not been innovative to engage the disabled people's group in the various components of CBR. This has also been one of the factors why DPOs have not been effective in our country.

A CBR programme today is expected to address all the five components of “

However, many of the CBR programme are greatly influenced by the strength of the NGO. Based on this the CBR programme will have a greater focus in health or education. However to develop a wholsitic CBR programme the NGO has to liaise and collaborate with other agencies or Govt. department to address the components such as livelihood, empowerment to make CBR complete.

It is important that CBR programme do not compete with other CBR programmes either run by NGOs or the Government in a given geographical area but the programmes must complement each other.

For the sustainability of the CBR programme it is of utmost importance that the CBR programme works hand-in-hand with the local Disabled people's group and the Government.

Another dimension for ˜innovation" could be. The CBR programme should work towards ensuring all Government development schemes such as poverty reduction include persons with disabilities. The task of advocating policy changes is impossible by any single NGO or a DPO “ hence all the CBR programmes and the DPO in a particular district or state must network as a federation. Failures of the past must not deter us from forming federations of CBR at different levels.

Lastly, the most important link in bringing about innovations and changes in the programme are the team of community facilitators/ CBR workers. It is ultimately the people in the field who make the difference in any CBR programme. We know that the best workers are those who come from a similar community background “ often themselves having disabilities. But these workers are themselves often poor and have all the pre-occupations and demands on their time that poverty exact. This is particularly true for women workers. And this in some ways requires a more sensitive and sophisticated set of management skills. And it is important that the innovations invest resources in building the capacities of the field team.

The brochure provided by CBR Forum for this seminar has also amply described the relevance and need for hosting such exchange programmes which provided us an opportunity to learn from each other and expand our horizons.

CBR needs to go beyond providing a service to people with disabilities. Today CBR is being promoted as the Millennium Development Goals (MDG) for people with disabilities.

The bottom line is ˜For long disabled people have been excluded ˜What is available for the non-disabled must be available for the disabled people"

Finally I would end by saying the quotation ˜Nothing about us without us" it is a belief that has can be put into practice only by involving persons with disabilities in all matters concerning them and it is up to all of us to demonstrate and ensure this is made possible in our programmes.

I wish all the success for the seminar.

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