Community Based Rehabilitation CBR


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CBR is a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities

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Community Based Rehabilitation CBR

  1. 1. Community-Based Physiotherapy Basic Concepts 1 ‫العالج الطبيعي المجتمعي‬ ‫مفاهيم أساسية‬ DR. AHMED-REFAT REFAT T I B A H U N I V E R S I T Y, K S A 1432 H. Dr. Ahmed Refat AG Refat
  2. 2. Basic Concepts – 1: Health 21- Health it is “a state of complete physical, mental and social well-being and not merely the presence of disease or infirmity” .Health is a valuable resource that enables people to lead individually, socially and economically productive lives, providing them with the freedom to work, learn and engage actively in family and community life. Dr. Ahmed Refat AG Refat
  3. 3. 2- Disability & Rehabilitation 3 The most recent definitions of disability come from the: International Classification of Functioning, Disability and Health (ICF), which states that disability is: An “umbrella term for impairments, activity limitations or participation restrictions” , which result from the interaction between the person with a health condition and environmental factors (e.g. the physical environment, attitudes), and personal factors (e.g. age or gender). Dr. Ahmed Refat AG Refat
  4. 4. 2-Disability & Rehabilitation- cont., 4Convention on the Rights of Persons with Disabilities, which states that disability is:An evolving concept and “results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others” . Dr. Ahmed Refat AG Refat
  5. 5. 2-Disability & Rehabilitation- cont., 5 People‟s experiences of disability are extremely varied. There are different kinds ofimpairments and people are affected in different ways. Some people have one impairment, others multiple; some are born with an impairment, while others may acquire an impairment during the course of their life The Convention on the Rights of Persons with Disabilities describes people with disabilities as “…those who have long-term physical, mental, intellectual or sensory impairments…” . Dr. Ahmed Refat AG Refat
  6. 6. 2-Disability & Rehabilitation- cont., 6Disability is no longer viewed as merely the result of impairment. The social model of disability has increased awareness that environmental barriers to participation are major causes of disability. The International Classification of Functioning, Disabilityand Health (ICF) includes body structure and function, but also focuses on „activities‟ and „participation‟ from both the individual and the societal perspective. Dr. Ahmed Refat AG Refat
  7. 7. Disability : Global Statistics 7 • Approximately 10% of the world‟s population lives with a disability ..• People with disabilities constitute the world‟s largest minority.• An estimated 80% of people with disabilities live in developing countries • An estimated 15 –20% of the world‟s poorest people are disabled• No rehabilitation services are available to people with disabilities in 62 countries .• Only 5–15% of people with disabilities can access assistive devices in the developingworld• Children with disabilities are much less likely to attend school than others• People with disabilities tend to experience higher unemployment and have lower earnings than people without disabilities .Dr. Ahmed Refat AG Refat
  8. 8. Community-Based Physiotherapy 8Origen of the " Community-based physiotherapy / rehabilitation (CBR)" concept The declaration of Alma-Ata in 1978 was the first international declaration advocating primary health care as the main strategy for achieving the World Health Organization‟s (WHO) goal of “health for all” . This strategy was intended to enhance the quality of life for people with disabilities through community initiatives. Dr. Ahmed Refat AG Refat
  9. 9. Community-Based Physiotherapy 9 Following the Alma-Ata declaration, WHO introduced CBR. In the beginning CBR was primarily a service delivery method making optimum use of primary health care and community resources, and was aimed at bringing primary health care and rehabilitation services closer to people with disabilities, especially in low-income countries .Dr. Ahmed Refat AG Refat
  10. 10. Community-Based Physiotherapy 10 During the 1990s, along with the growth in number of CBR programmes, there were changes in the way CBR was conceptualized. Other UN agencies, such as the International Labour Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO), United Nations Development Programme (UNDP), and United Nations Children‟s Fund (UNICEF) became involved, recognizing the need for a multisectoral approach.Dr. Ahmed Refat AG Refat
  11. 11. Community-Based Physiotherapy 11 In 2003, an International consultation to review community-based rehabilitation held in Helsinki made a number of key recommendations . Subsequently, CBR was repositioned, in a joint International Labour Organization (ILO)/United Nations Educational, Scientific and Cultural Organization (UNESCO)/WHO position paper, as a strategy within general community development for the rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities . Dr. Ahmed Refat AG Refat
  12. 12. Community-Based Physiotherapy 12 CBR is implemented through the combined efforts of people with disabilities themselves, their families, organizations and communities, and the relevant governmental and non-governmental health, education, vocational, social and other services. ( ILO, UNICEF, WHO. CBR: joint position paper ; 2004 ).Dr. Ahmed Refat AG Refat
  13. 13. Elements of CBR 13 Essential Elements of CBR CBR requires community and DPO involvement. But communities and DPOs cannot work alone to ensure equal opportunities for people with disabilities. National policies, a management structure, and the support of different government ministries, NGOs and other stakeholders (multi-sectoral collaboration) are also needed. Dr. Ahmed Refat AG Refat
  14. 14. Sustainability of CBR Programmes 14 Country approaches to implementing CBR vary a great deal, but they have some elements in common that contribute to the sustainability of their CBR programmes. These include: I. National level support through policies, co-ordination and resource allocation. II. Recognition of the need for CBR programmes to be based on a human rights approach. III. The willingness of the community to respond to the needs of their members with disabilities. IV. The presence of motivated community workers.Dr. Ahmed Refat AG Refat
  15. 15. Support for CBR 15Multi-sectoral Support for CBR In CBR a multi-sectoral collaboration is essential to support the community, address the individual needs of people with disabilities, and strengthen the role of DPOs.Dr. Ahmed Refat AG Refat
  16. 16. Support for CBR 16 1 Support from the Social Sector 2 Support from the Health Sector 3 Support from the Educational Sector 4 Support from the Employment Sector 5 Support from NGOs 6 Support from the MediaDr. Ahmed Refat AG Refat
  17. 17. Principles of CBR 17 CBR facilitates access to basic needs, and at the same time promotes equal opportunities and equal rights. It is therefore a multisectoral strategy with some key principles to enable people with disabilities to participate in the whole range of human activities. The principles outlined below are overlapping, complementary and inter-dependentDr. Ahmed Refat AG Refat
  18. 18. Principles of CBR 181. Inclusion2. Participation3. Empowerment4. Equity5. Self -advocacy6. Facilitation7. Gender sensitivity and special needs8. Partnerships9. SustainabilityDr. Ahmed Refat AG Refat
  19. 19. Principles of CBR 19 1- Inclusion CBR works to remove all kinds of barriers which block people with disabilities from access to the mainstream of society. Inclusion means placing disability issues and people with disabilities in the mainstream of activities. 2- Participation CBR focuses on abilities, not disabilities. It depends on the participation and support of people with disability, family members and local communities. It also means the involvement of people with disabilities as active contributors to the CBR programme, from policy-making to implementation and evaluation, for the simple reason that they know what their needs are.Dr. Ahmed Refat AG Refat
  20. 20. Principles of CBR 20 3- Empowerment Local people – and specifically people with disabilities and their families, ultimately may make the programme decisions and control the resources. This requires people with disability taking leadership roles within programmes. It means ensuring that CBR workers, service providers and facilitators include people with disabilities and that all are adequately trained and supported. Results are seen in restored dignity and self-confidence.Dr. Ahmed Refat AG Refat
  21. 21. Principles of CBR 21 4- Equity CBR emphasizes equality of opportunities and rights – equal citizenship. Raising awareness CBR addresses attitudes and behaviour within the community, developing understanding and support for people with disabilities and ensuring sustainable benefits. It also promotes the need for and benefit of inclusion of disability in all developmental initiatives.Dr. Ahmed Refat AG Refat
  22. 22. Principles of CBR 22 5- Self Advocacy., CBR consistently involves people with disabilities in all issues related to their well-being. Selfadvocacy is a collective notion, not an individualistic one. It means self-determination. It means mobilizing, organizing, representing, and creating space for interactions and demands. Dr. Ahmed Refat AG Refat
  23. 23. Principles of CBR 23 6- Facilitation CBR requires multisectoral collaboration to support the community and to address the individual needs of people with disability, with the ultimate aim of an inclusive society. 7- Gender sensitivity and special needs CBR is responsive to individuals and groups within the community with special needs.Dr. Ahmed Refat AG Refat
  24. 24. Principles of CBR 24 8- Partnerships CBR depends on effective partnerships with community-based organizations, government organizations and other organized groups. 9- Sustainability CBR activities must be sustainable beyond the immediate life of the programme itself. They must be able to continue beyond the initial interventions, and be independent of the initiating agency. The benefits of the programme must be long-lasting.Dr. Ahmed Refat AG Refat
  25. 25. Common Framework of CBR Programmes 25 In light of the evolution of CBR into a broader multisectoral development strategy, a matrix was developed in 2004 to provide a common framework for CBR programme . The matrix consists of five key components: the health, education, livelihood, social and empowerment components.Within each component there are five elements.Dr. Ahmed Refat AG Refat
  26. 26. CBR Matrix 26Dr. Ahmed Refat AG Refat
  27. 27. Elements of Health Components -1 271- Health promotion Health promotion aims to increase control over health and its determinants. The wide range of strategies and interventions available are directed at strengthening the skills of individuals and changing social, economic and environmental conditions to alleviate their impacts on health.Dr. Ahmed Refat AG Refat
  28. 28. Elements of Health Components -2 282- Prevention Prevention is very closely linked with health promotion. Prevention of health conditions (e.g. diseases, disorders, injuries) involves primary prevention (avoidance), secondary prevention (early detection and early treatment) and tertiary prevention (rehabilitation) measures. The focus of this element is mainly on primary prevention.Dr. Ahmed Refat AG Refat
  29. 29. Elements of Health Components -3 293- Medical care Medical care refers to the early identification, assessment and treatment of health conditions and their resulting impairments, with the aim of curing or limiting their on individuals. Medical care can take place at the primary, secondary or tertiary level of the health-care system.Dr. Ahmed Refat AG Refat
  30. 30. Elements of Health Components -4 304- Rehabilitation Rehabilitation is a set of measures which enables people with disabilities to achieve and maintain optimal functioning in their environments; it is relevant both for those who acquire disabilities during their lifetime and for those who have disabilities from birth. Rehabilitation services range from the basic to the specialized and are provided in many different locations e.g. hospitals, homes and community environments. Rehabilitation is often initiated by the health sector but requires collaboration between all sectors.Dr. Ahmed Refat AG Refat
  31. 31. Elements of Health Components -5 315- Assistive devices A device that has been designed, made or adapted to assist a person to perform a particular task is known as an assistive device. Many people with disabilities benefit from the use of one or more assistive devices. Some common types of assistive devices are: mobility devices (e.g. walking sticks, wheelchairs), prostheses (e.g. artificial legs), orthoses (e.g. hand splint), visual devices (e.g. glasses, white canes) and hearing devices (hearing aids). To ensure that assistive devices are used effectively, important aspects of their provision include user education, repair, replacement and environmental adaptations in the home and community.Dr. Ahmed Refat AG Refat
  32. 32. 32 Desired Outcome and the Role of CBR in each Elements of Health ComponentDr. Ahmed Refat AG Refat
  33. 33. 1- Health Promotion, 33Goal The health potential of people with disabilities and their families is recognized and they are empowered to enhance and/or maintain existing levels of health.The role of CBR The role of CBR is to identify health promotion activities at a local, regional and/or national level and work with stakeholders (e.g. ministries of health, local authorities) to ensure access and inclusion for people with disabilities and their family members. Another role is to ensure that people with disabilities and their families know the importance of maintaining good health and encourage them to actively participate in health promoting actions.Dr. Ahmed Refat AG Refat
  34. 34. 1- Health Promotion-cont, 34Desirable outcomes • People with disabilities and their families are reached by the same health promotion messages as are members of the general community. • Health promotion materials and programmes are designed or adapted to meet the specific needs of people with disabilities and their families. • People with disabilities and their families have the knowledge, skills and support to assist them to achieve good levels of health.Dr. Ahmed Refat AG Refat
  35. 35. 1- Health Promotion-cont, 35Desirable outcomes Health-care personnel have improved awareness about the general and specific health needs of people with disabilities and respond to these through relevant health promotion actions. • The community provides a supportive environment for people with disabilities to participate in activities which promote their health. • CBR programmes value good health and undertake health-promoting activities in the workplace for their staff.Dr. Ahmed Refat AG Refat
  36. 36. 2- Prevention , 36The role of CBR The role of CBR is to ensure that communities and relevant development sectors focus on prevention activities for people both with and without disabilities. CBR programmes provide support for people with disabilities and their families to ensure they can access services that promote their health and prevent the development of general health conditions or secondary conditions (complications).Dr. Ahmed Refat AG Refat
  37. 37. 2- Prevention -cont, 37Desirable outcomes • People with disabilities and their families have access to health information and services aimed at preventing health conditions. • People with disabilities and their families reduce their risk of developing health problems by taking up and maintaining healthy behaviours and lifestyles. People with disabilities are included and participate in primary prevention activities, e.g. immunization programmes, to reduce their risk of developing additional healthconditions or impairments.Dr. Ahmed Refat AG Refat
  38. 38. 2- Prevention -cont, 38Desirable outcomes All community members participate in primary prevention activities, e.g.immunization programmes, to reduce their risk of developing health conditions or impairments which can lead to disability. • CBR programmes collaborate with the health and other sectors, e.g. education, to address health issues and provide support and assistance for prevention activities.Dr. Ahmed Refat AG Refat
  39. 39. 3- Medical Care 39 Goal People with disabilities access medical care, both general and specialized, based on their individual needs.The role of CBR The role of CBR is to work in collaboration with people with disabilities, their families and medical services to ensure that people with disabilities can access services designed to identify, prevent, minimize and/or correct health conditions and impairments.Dr. Ahmed Refat AG Refat
  40. 40. 3- Medical Care -cont, 40Desirable outcomes • CBR personnel are knowledgeable about medical care services and able to facilitate referrals for people with disabilities and their families for general or specialized medical care needs. • People with disabilities and their families access activities that are aimed at the early identification of health conditions and impairments (screening services). • Medical care facilities are inclusive and have improved access for people with disabilities. • People with disabilities can access surgical care to minimize or correct impairments, thus contributing to improved health and functioning. • People with disabilities and their families develop self-management skills whereby they are able to ask questions, discuss treatment options, make informed decisions about medical care and manage their health conditions. • Medical care personnel have increased awareness regarding the medical needs of people with disabilities, respect their rights and dignity and provide quality services.Dr. Ahmed Refat AG Refat
  41. 41. 4- Rehabilitation, 41Goal People with disabilities have access to rehabilitation services which contribute to their overall well-being, inclusion and participation.The role of CBR The role of CBR is to promote, support and implement rehabilitation activities at the community level and facilitate referrals to access more specialized rehabilitation services.Dr. Ahmed Refat AG Refat
  42. 42. 4- Rehabilitation -cont, 42Desirable outcomes • People with disabilities receive individual assessments and are involved in the development of rehabilitation plans outlining the services they will receive. • People with disabilities and their family members understand the role and purpose of rehabilitation and receive accurate information about the services available within the health sector.Dr. Ahmed Refat AG Refat
  43. 43. 4- Rehabilitation -cont, 43Desirable outcomes People with disabilities are referred to specialized rehabilitation services and are provided with follow-up to ensure that these services are received and meet their needs. • Basic rehabilitation services are available at the community level. • Resource materials to support rehabilitation activities undertaken in the community are available for CBR personnel, people with disabilities and families. • CBR personnel receive appropriate training, education and support to enable them to undertake rehabilitation activities.Dr. Ahmed Refat AG Refat
  44. 44. 4- Rehabilitation-cont, 44Rehabilitation services (e.g. nurses, physiatrists), therapy professionals (e.g. occupational therapists, physiotherapists, speech therapists), technology specialists (e.g. orthotists, prosthetists) and rehabilitation workers (e.g. rehabilitation assistants, community rehabilitation workers). Rehabilitation services can be offered in a wide range of settings, including hospitals, clinics, specialist centres or units, community facilities and homes. Dr. Ahmed Refat AG Refat
  45. 45. 5- Assistive Devices 45 Goal People with disabilities have access to appropriate assistive devices that are of good quality and enable them to participate in life at home and work and in the community. The role of CBR The role of CBR is to work with people with disabilities and their families to determine their needs for assistive devices, facilitate access to assistive devices and ensure maintenance, repair and replacement when necessary.Dr. Ahmed Refat AG Refat
  46. 46. 5- Assistive Devices-cont, 46 Desirable outcomes CBR personnel are knowledgeable about assistive devices, including the types available, their functionality and suitability for different disabilities, basic fabrication, availability within communities and referral mechanisms for specialized devices. People with disabilities and their families are knowledgeable about assistive devices and make informed decisions to access and use them. People with disabilities and their families are provided with training, education and follow-up to ensure they use and care for their assistive devices appropriately. Local people, including people with disabilities and their families, are able to fabricate basic assistive devices and undertake simple repairs and maintenance. Barriers preventing access to assistive devices, such as inadequate information, financial constraints and centralized service provision, are reduced. Environmental factors are addressed to enable individuals to use their assistive devices in all locations where they are needed.Dr. Ahmed Refat AG Refat
  47. 47. Literature Cited 47 1- WHO: Community-based rehabilitation guidelines 2- World Bank: Community Based Rehabilitation (CBR): 3- The United Nations Economic and Social Commission for Asia and the Pacific (ESCAP)Understanding Community-Based Rehabilitation 4- CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities (Joint Position Paper 2004) 5. Declaration of Alma-Ata: International conference on primary health care, Alma-Ata, USSR, 6–12September 1978, Geneva, World Health Organization, 1978 (, accessed 10 August 2010). 6. International Labour Organization, United Nations Educational, Scientific and Cultural Organization,World Health Organization. CBR: A strategy for rehabilitation, equalization of opportunities, povertyreduction and social inclusion of people with disabilities. Joint Position Paper 2004. Geneva, World Health Organization, 2004 (, accessed 10 August 2010). Dr. Ahmed Refat AG Refat
  48. 48. ‫شكرا‬ 48Thank You Ahmed-Refat