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Community Based Rehabilitation

Am Papri Das, M. Sc (N) Community Health Nursing faculty with more than 23 yrs of experience working as Vice-Principal at Peerless College of Nursing. Power point presentation on topic "Community Based Rehabilitation" It will be of great help to Nursing student in graduate and post graduate level. as possible in the interest of the students. Hope the topic will be beneficial to the students folk.

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Community Based Rehabilitation

  1. 1. COMMUNITY BASED REHABILITATION Presented By- Ms. Papri Das Assistant Professor Peerless College of Nursing
  2. 2. The emergence of the concept ofThe emergence of the concept of Community Based RehabilitationCommunity Based Rehabilitation “If you give a person a fish, he’ll eat for a day; if you teach him to fish, he’ll eat for a lifetime.”
  3. 3. The emergence of the concept ofThe emergence of the concept of Community Based RehabilitationCommunity Based Rehabilitation “If you give a person a fish, he’ll eat for a day; if you teach him to fish, he’ll eat for a lifetime.”
  4. 4. Community Based Rehabilitation (CBR) brings rehabilitation know-how to villages and urban slums, and CBR personnel facilitate people to take responsibility for their own lives!
  5. 5. WHATWHAT IS CBR?IS CBR? CBRCBR isis aa systematizedsystematized approachapproach withinwithin general community developmentgeneral community development wherebywhereby Persons with DisabilitiesPersons with Disabilities areare enabledenabled toto livelive aa fulfilling lifefulfilling life within theirwithin their own communityown community,,
  6. 6. making maximum use ofmaking maximum use of local resourceslocal resources and helping theand helping the community becomecommunity become awareaware of it’s responsibility in ensuring theof it’s responsibility in ensuring the inclusion andinclusion and equalequal participation of PWDs.participation of PWDs. In the process,In the process, PWDsPWDs areare also madealso made awareaware of their own role and responsibility, as theyof their own role and responsibility, as they are part of the community.are part of the community.
  7. 7. Definition of CBRDefinition of CBR ““a strategy within general communitya strategy within general community development for thedevelopment for the rehabilitation,rehabilitation, equalization of opportunities and socialequalization of opportunities and social inclusion ofinclusion of all people withall people with disabilities.disabilities.””
  8. 8. CBR isCBR is implementedimplemented through the combinedthrough the combined efforts of PWDs themselves, their families,efforts of PWDs themselves, their families, organizations and communities, and theorganizations and communities, and the relevant governmental and non-governmentalrelevant governmental and non-governmental health, education, vocational, social andhealth, education, vocational, social and other services.other services.
  9. 9. Side stream Your Boat Mainstream What if you are in the Mainstream? What if you are in the Side stream?
  10. 10. Mainstreaming and inclusionMainstreaming and inclusion  Mainstreaming and inclusion is seen as anMainstreaming and inclusion is seen as an effective way:effective way: (a) to include persons with disability(a) to include persons with disability (b) to give equal opportunities and(b) to give equal opportunities and (c) to provide a non-discriminative(c) to provide a non-discriminative environment for their growth andenvironment for their growth and development.development.
  11. 11. Major ObjectivesMajor Objectives To ensure that PWDs are able to maximize their physicalTo ensure that PWDs are able to maximize their physical and mental abilities,and mental abilities, to access regular services and opportunities, and toto access regular services and opportunities, and to become active contributors to the community andbecome active contributors to the community and society at large.society at large. To activate communities to promote and protect theTo activate communities to promote and protect the human rights of PWDs through changes within thehuman rights of PWDs through changes within the community, for example, by removing barriers tocommunity, for example, by removing barriers to participation.participation.
  12. 12. Evolution ofEvolution of Concepts in CBRConcepts in CBR  Disability and RehabilitationDisability and Rehabilitation  Disability is no longer viewed as merely the result of impairment.  The social model of disability has increased the awareness that environmental barriers (attitudinal, physical and institutional) to participation impede the functioning of PWDs as equals.
  13. 13. Evolution ofEvolution of Concepts in CBRConcepts in CBR  Disability and RehabilitationDisability and Rehabilitation  Professionals (medical and other) who provide rehabilitation services have the responsibility to provide relevant information to PWDs / their families so that they can make informed decisions to enable them to lead a fulfilling life.
  14. 14. Evolution ofEvolution of Concepts in CBRConcepts in CBR  Human RightsHuman Rights  CBR promotes the rights of PWDs to live as equal citizens within the community, to enjoy health and well being, to participate fully in educational, social, cultural, religious, economic and political activities.
  15. 15. Evolution ofEvolution of Concepts in CBRConcepts in CBR  PovertyPoverty  There is a strong correlation between disability and poverty.  Poverty leads to increased disability, and disability in turn leads to increased poverty.
  16. 16. Evolution ofEvolution of Concepts in CBRConcepts in CBR  PovertyPoverty  In 2000, the UN Member States adopted the Millennium Declaration and set eight Millennium Development Goals (MDGs) to guide the implementation of the Declaration. All the goals are relevant to disability and three goals are of particular concern to PWDs and their families:
  17. 17. Eradicate severe poverty and hunger. Promote gender equality and empower women. None of these goals can be effectively achieved without the inclusion of PWDs Reduce mortality and Morbidity
  18. 18. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME The principles are overlapping, complimentary and inter-dependent – they cannot be separated one from the other. Source: World Health Organization: Meeting Report on the development of guidelines for Community Based Rehabilitation (CBR) programmes : (1 st and 2 nd November 2004, Geneva, Switzerland) HOW
  19. 19. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  InclusionInclusion  Inclusion means the removal of all kinds of barriers which block PWDs from access to the mainstream.  Inclusion means placing disability issues and PWDs in the mainstream of activities, rather than as an after-thought.  Inclusion means including all forms of impairment.
  20. 20. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  InclusionInclusion  Inclusion also means ‘convergence’ – that is, the involvement of PWDs in the campaigns, struggles and activities of other oppressed groups which are not centred exclusively on disability issues, such as children living on the streets, farmers, land rights and environment, women’s groups.
  21. 21. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  ParticipationParticipation  Participation means the involvement of PWDs as active contributors to the CBR programme from policy making to implementation and evaluation, for the simple reason that they know best what they need.
  22. 22. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  ParticipationParticipation  Participation also means PWDs being a critical resource within any CBR programme – providing training, making decisions etc.  It covers the participation of women in all processes and decision-making, and that of other groups who are typically not listened to or excluded.
  23. 23. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  SustainabilitySustainability  The benefits of the programme must be lasting.  The activity initiated through the CBR programme must be sustainable beyond the immediate life of the programme itself – able to continue beyond the initial intervention and thrive independently of the initiating agency.
  24. 24. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  SustainabilitySustainability  Strong links between GOs, NGOs, CBOs and DPOs will contribute towards sustainability.  This means that DPOs and SHGs are the hub of any CBR activity.
  25. 25. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  EmpowermentEmpowerment  Empowerment means that local people, and specifically PWDs and their families, make the programme decisions and control the resources.  It means PWDs taking leadership roles within programmes.
  26. 26. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  EmpowermentEmpowerment  The empowerment of women is central to any programme.  Empowerment necessitates capacity building – that is, the developing and using of the skills necessary to act with authority and responsibility, independent of the initiating agencies and CBR programme managers.
  27. 27. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  AdvocacyAdvocacy  Advocacy means the central and consistent involvement of PWDs and their families defining for themselves the goals and processes for poverty alleviation.
  28. 28. BASIC PRINCIPLES OFBASIC PRINCIPLES OF A CBR PROGRAMMEA CBR PROGRAMME  AdvocacyAdvocacy  Advocacy is a collective notion not an individualistic one. It means self- determination.  It means mobilizing, organizing, representing, creating space for interaction and demands.
  29. 29. ESSENTIAL COMPONENTS OFESSENTIAL COMPONENTS OF A CBR PROGRAMMEA CBR PROGRAMME 1. Cover all types of PWDs who need rehabilitation services. 2. Part of mainstream development and have a multi-sectoral approach : including social integration interventions, health, education and economic programmes. 3. The programme should have access to or generate a good and effective referral system.
  30. 30. 4.4. The programme should aim atThe programme should aim at fullfull integration of the PWDintegration of the PWD into his / herinto his / her community.community. 5.5. The programme should haveThe programme should have gender andgender and disability focus and balancedisability focus and balance.. 6.6. The programme needs to haveThe programme needs to have committed and well trained communitycommitted and well trained community members as service providersmembers as service providers..
  31. 31. 5.5. The programme shouldThe programme should strike a balancestrike a balance between provision of service delivery andbetween provision of service delivery and empowering the PWD, family and communityempowering the PWD, family and community through regular transfer of skills.through regular transfer of skills. 6.6. The programme shouldThe programme should facilitate the formationfacilitate the formation and strengthening of the disabled people’sand strengthening of the disabled people’s movement to ensure that the rights of themovement to ensure that the rights of the PWDs are not deniedPWDs are not denied through advocacy atthrough advocacy at local, state and national level.local, state and national level.
  32. 32. COMMUNITY BASED REHABILITATION PRINCIPLES: PARTICIPATION ~ INCLUSION ~ SUSTAINIBILITY ~ SELF ADVOCACY HEALTH PROMOTIVE PREVENTIVE CURATIVE REHABILITATIVE EDUCATION EARLY CHILDHOOD DEVELOPMENT NON-FORMAL FORMAL SCHOOL HIGHER LIVELIHOODS SKILLS DEVELOPMENT INCOME GENERATING ACTIVITIES ACCESS TO FINANCIAL SERVICES OPEN EMPLOYMENT EMPOWERMENT SELF-HELP GROUPS DISABLED PEOPLE'S ORGANIZATION SOCIAL MOBILISATION POLITICAL EMPOWERMENT SOCIAL LEGAL PROTECTION CULTURE & RELIGION SPORTS & LEISURE RELATIONSHIP MARRIAGE & FAMILY ASSISTIVE DEVICES SPECIAL/ TRANSITORY ECONOMIC CONTRIBUTION & SOCIAL PROTECTION LANGUAGE & COMMUNICATION PERSONAL ASSISTANCE GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~GOAL: HUMAN RIGHTS ~ SOCIO-ECONOMIC DEVELOPMENT ~ POVERTY ALLEVIATIONPOVERTY ALLEVIATION WHO MATRIX
  33. 33. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from the Social SectorSupport from the Social Sector:: Examples: dExamples: disability pensions, technicalisability pensions, technical aids and adaptations, vocational trainingaids and adaptations, vocational training and employment, and co-ordination ofand employment, and co-ordination of referrals for individuals who requirereferrals for individuals who require services from other sectorsservices from other sectors
  34. 34. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from NGOsSupport from NGOs andand the local communitythe local community::  Most communities have a variety ofMost communities have a variety of non-governmental organizationsnon-governmental organizations (NGOs) and groups that can(NGOs) and groups that can contribute to a CBRcontribute to a CBR programme.programme.
  35. 35. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from theSupport from the HealthHealth SectorSector:: The Declaration of Alma Ata (1978)The Declaration of Alma Ata (1978) states that Primary Health Care (PHC) isstates that Primary Health Care (PHC) is the key to attaining health for all. It alsothe key to attaining health for all. It also states that the PHC needs to address thestates that the PHC needs to address the main health problems in the community,main health problems in the community, providing promotive, preventive, curativeproviding promotive, preventive, curative and rehabilitative services.and rehabilitative services.
  36. 36. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from theSupport from the HealthHealth SectorSector:: PHC can play a major role in this contextPHC can play a major role in this context both as a provider and supporter:both as a provider and supporter:  Early identification of impairments andEarly identification of impairments and providing basic interventions.providing basic interventions.  Referrals to specialized services such asReferrals to specialized services such as physical, occupational and speechphysical, occupational and speech therapies; prosthetics andtherapies; prosthetics and orthotics; andorthotics; and corrective surgeries.corrective surgeries.
  37. 37. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from theSupport from the EducationalEducational SectorSector::  Adapting the content of the curriculumAdapting the content of the curriculum and methods of teaching.and methods of teaching.  Ensuring that classrooms, facilities andEnsuring that classrooms, facilities and educational materialseducational materials are accessible.are accessible.  Children with multiple or severeChildren with multiple or severe disabilitiesdisabilities may access education throughmay access education through the use of innovative methods best suitedthe use of innovative methods best suited to their context.to their context.
  38. 38. Multi-sectoral Support for CBRMulti-sectoral Support for CBR Support fromSupport from the Employmentthe Employment and Labourand Labour SectorSector::  Collaboration with the employment andCollaboration with the employment and labour sectors. Productive and decentlabour sectors. Productive and decent work in a conducive environmentwork in a conducive environment  Equal employmentEqual employment opportunities throughopportunities through national policies and legislation;national policies and legislation;
  39. 39. Multi-sectoral Support for CBRMulti-sectoral Support for CBR  Support from the MediaSupport from the Media ::  All CBR stakeholders should workAll CBR stakeholders should work closely with theclosely with the media to identifymedia to identify priorities and to provide relevantpriorities and to provide relevant information.information.
  40. 40. MOVING TOWARDSMOVING TOWARDS AN EFFECTIVE CBR PROGRAMMEAN EFFECTIVE CBR PROGRAMME  The following aspects of CBR need to be strengthened to make programmes more effective: 1. Community Involvement and Ownership 2. Multi-sectoral collaboration in CBR programmes 3. Involvement of DPOs in CBR programmes 4. Scaling up CBR programmes 5. CBR programmes to be used as an effective tool for poverty reduction 6. Evidenced based practice
  41. 41. Who Initiates CBR ?Who Initiates CBR ?  Community action for CBR is often initiatedCommunity action for CBR is often initiated by aby a stimulus from outside the communitystimulus from outside the community,, most likely ministries or NGOs.most likely ministries or NGOs.  It is theIt is the communitycommunity which decides whetherwhich decides whether CBR will become part of its ongoingCBR will become part of its ongoing community development activities.community development activities.
  42. 42. COMPONENTS NEEDEDCOMPONENTS NEEDED TO BEGIN A PROGRAMME FORTO BEGIN A PROGRAMME FOR THE REHABILITATION OF PWDsTHE REHABILITATION OF PWDs Look out for…. 1. An action area where the need is apparent. 2. A community which is receptive. 3. A resourceful and creative outside agency. 4. Persons with Disabilities who need the services of external agency , community for mainstreaming themselves, to set themselves up as contributors and not just recipients of service.
  43. 43. Steps of CBRSteps of CBR 1.1. Identification of person requiringIdentification of person requiring rehabilitation services.rehabilitation services. 2.2. Assessment of disabilities and variousAssessment of disabilities and various needs for rehabilitation of identifiedneeds for rehabilitation of identified person.person. 3.3. Provide the basic services through PHC,Provide the basic services through PHC, such as drugs, dressing, materials,such as drugs, dressing, materials, protective foot wear, counseling andprotective foot wear, counseling and training in self care.training in self care.
  44. 44. 4.4. Introduce / escort the person to villageIntroduce / escort the person to village health committee along with his/herhealth committee along with his/her problems.problems. 5.5. Refer to secondary/ tertiary care centersRefer to secondary/ tertiary care centers 6.6. Facilitating the accessibility to socio-Facilitating the accessibility to socio- economic rehabilitation services.economic rehabilitation services. 7.7. Review meetings by all stake holders, toReview meetings by all stake holders, to discuss progress.discuss progress. 8.8. Coordination with social welfareCoordination with social welfare department and working jointly.department and working jointly.
  45. 45. Challenges of CBRChallenges of CBR  Lack of understanding of concept.  Rapid turn over of civil servants, Finance / Prioritization.  Acceptance of CBR as a valid intervention.  Poor Management / planning of CBR
  46. 46.  Inter Ministerial Rivalry - Lack ofInter Ministerial Rivalry - Lack of communicationcommunication  Evidence based facts not made availableEvidence based facts not made available  Lack of co-ordination between theLack of co-ordination between the Government and NGO’sGovernment and NGO’s  Social welfare department often has aSocial welfare department often has a weak structure at community level.weak structure at community level.
  47. 47. We look forward to a tomorrowWe look forward to a tomorrow that includes PWDs in the mainstream as equal partners that does not side stream PWDs

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