International Community Based Rehabilitation Programs Around the World
Original Article written by Gene R Rogers
Community Based Rehabilitation (CBR) may be defined, according to three United Nation Agencies, ILO, UNESCO, and the WHO, as a "strategy within community development for the rehabilitation, equalization of opportunities, and social integration of all people with disabilities. CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" (WHO, 1994) Click me for a more complete description. It differs from Independent Living in that, according to Lysack (1994), the entire community is the target of CBR programs;.the CBR model is one of community development or partnership; IL ideology places control squarely with disabled consumers.
The United States builds the best rehabilitation institutions in the world. People don't live in institutions though; they live in their community. They should be rehabilitated (or habilitated) in their community by and with people in their community. This page is dedicated to the proposition that rehabilitation is too important to be left to professionals.
The purpose of this web page is to facilitate the worldwide exchange of CBR information. By sharing this information I expect to learn of methods or programs in developing countries, that may be beneficial in the rural southwest USA. Please tell me what CBR programs you think have practices or methods that could be replicated in the USA. As an example, in one country there is a CBR program in which people travel from village to village to put on a puppet show that conveys the message that pregnant woman should not drink alcohol as that may cause birth defects. In the Southwest USA, particularly with Native American Indian populations, we have a high incidence of Fetal Alcohol Syndrome (FAS). Perhaps a "puppet show" type program can help prevent developmental disabilities in the USA. I would like to hear your ideas.
Gene would always like to hear your thoughts on:
- The difference between CBR and rural rehabilitation programs.
- The difference between traditional CBR programs and new programs promoted as CBR programs in developed countries.
- Your recommendations on making this web site more useful or more readable.
I have included two pdf files you can download. The first file compares CBR with Independent Living. The second describes an early intervention program called Portage. You will need Adobe Acrobat 3.0 to read these files. If you don't have Acrobat you can download it free from http://www.adobe.com/prodindex/acrobat/readstep.html
The following two files are chapters from the report I wrote about CBR.
If you have technical problems downloading or opening these stories, please let me know Geno@CBRresources.org
1/2, Kazi Nazrul Islam Road
Block-G, Lalmatia, Dhaka-1207 Miling: G.P.O. Box : 4208
Dhaka - 1000, Bangladesh
Executive Director - Shahidul Haque
The organization known as SARPV (Social Assistance and Rehabilitation for the Physically Vulnerable) was formed on the 17th April, 1988. The field level activities started in 1991 with a skill training center for the orthopeadically disabled persons at Mohammadpur of the capital city. Necessarily it is a social product. Realization of disabled persons themselves during their pursuit of education and job in the existing reality gave rise to a movement named SARPV.
964 Hamilton Ave
Palo Alto CA 94301
Fax: (415) 325-1080
HealthWrights is a non-profit organization committed to advancing the health, basic rights, social equality, and self-determination of disadvantaged persons and groups. We believe that health for all people is only possible in a global society where the guiding principles are sharing, mutual assistance, and respect for cultural and individual differences. David Werner, a founding member of HealthWrights, helped develop many CBR programs, including Project PROJIMO, and is author of "Where There is No Doctor", which has been translated into 83 different languages. See the books David has authored or co-authored.
May 9 2008
Dear friends of PROJIMO and HealthWrights,
It is with deep sadness that we share with you the news that Marcelo Acevedo died on May 7. The cause of death was brain cancer.
Marcelo was one of the founders of PROJIMO and worked with the program as a brace and limb maker for over 20 years.
Please read more about Marcelo and a plea for his family. Marcelo
Calle Constitución s/n (sin número)Col. Las Huertas Coyotitan Sinaloa México
International Phone 01(52) (696) 96 20115
In Mexico 01(696) 96 20115
The general objective of P.R.O.J.I.M.O. is to help persons with disabilities, for the purpose of recovering their dignity as human beings and at the same time, fighting for their rights and the rights of other disabled people to be integrated or reintegrated into the society. We are a small organization and community dedicated to improving the lives of the disabled people in need.
ICACBR (International Centre for the Advancement of Community Based Rehabilitation)
Kingston, Ontario, Canada
The International Centre for the Advancement of Community Based Rehabilitation (ICACBR) is an organization committed to advancing the concept and practice of community based rehabilitation in partnership with persons with disabilities and their communities around the world. All ofICACBR's activities are directed towards achieving excellence in education, research and service delivery in community based rehabilitation internationally.ICACBR has helped develop CBR programs in several countries and has published a compendium on CBR programs.
Healthlink Worldwide (formerly AHRTAG)
29-35 Farringdon Road
London EC1M 3JB
Fax: 011-44 171 242 0041
general enquiries: firstname.lastname@example.org
Victoria Richardson email@example.com
Healthlink Worldwide (formerly AHRTAG) has an extensive collection of CBR materials and publishes a CBR newsletter. Healthlink Worldwide works with more than 30 partner organizations in developing countries including governments, non-governmental organizations and academic institutes to run programs to support particular health needs. These include continuing education and training for health workers in Africa and the Middle East, AIDS and Sexual Health, Child Health and Disability.
1/2, Kazi Nazrul Islam Road
Block-G, Lalmatia, Dhaka-1207
Miling: G.P.O. Box : 4208
Dhaka - 1000, Bangladesh
To establish people with disabilities as an economic, social and a political force, the organization known as SARPV (Social Assistance and Rehabilitation for the Physically Vulnerable) was formed on the 17th April, 1988. The field level activities started in 1991 with a skill training center for the orthopeadically disabled persons at Mohammadpur of the capital city. Necessarily it is a social product. Realization of disabled persons themselves during their pursuit of education and job in the existing reality gave rise to a movement named SARPV. I have been in contact with the Executive Director - Shahidul Haque and am confident, that under Shahidul Haque's leadership, this CBR program will do quite well.
The UNDP Disability Action Group promotes Community-Based Rehabilitation (CBR) and the inclusion of disabled people in mainstream programs concerned with sustainable human development.
Wheeled Mobility Center, International Wheelchair Program
The Wheeled Mobility Center is the communications hub of the Whirlwind Wheelchair Network of independent wheelchair-producing workshops in developing countries. Founded in 1989, the Wheeled Mobility Center (WMC) is dedicated to creating wheeled technology that maximizes the quality of life for people throughout the world. For more information send email to: firstname.lastname@example.org
SIG 17,is a Special Interest Group of RESNA. It provides a forum for persons who are actively interested in providing appropriate rehabilitation technology and services to people in third world and other limited-resource countries.
SIG 17's current focus is on a project named Project Sorebutts. The aim of this project is to address the problem of pressure ulcers as they affect individuals in developing countries. We are also beginning a thrust in Alternative and Augmentative Communication in developing countries. If you'd like to become more involved with SIG 17, or simply receive more information, please EMail Janet Bednarczyk at email@example.com
Disabled People's International
101 - 7 Evergreen Place, Winnipeg, Manitoba, Canada R3L 2T3
Phone:(204) 287-8010 Fax:(204) 453-1367 TTY:(204) 284-2598
Disabled People's International (DPI)
The purpose of DPI is to promote the Human Rights of People with Disabilities through full participation, equalization off opportunity and development. DPI is a grassroots, cross-disability network with member organizations in over 110 countries, over half of which are in the developing world. DPI is administrated through the headquarters in Winnipeg, Canada and through eight Regional Development Offices. DPI has consultative status with the ECOSOC, UNESCO, WHO, and the ILO, and has official observer status at the United Nations General Assembly.
People To People Committee on Disability
PO Box 18131
Washington D.C. 20036
People to People Committee on Disability (PPCD)
Welcomes questions about all forms of international disability information. A non-profit organization working outside of government to promote international understanding and communication.
President and Secretary General
25 East 21st Street
New York, , NY 10010
Rehabilitation International (RI) is a federation of national, regional and international organizations and agencies working to promote the prevention of disability and the rehabilitation of disabled people throughout the world. RI is currently composed of 135 organizations leading disability prevention and rehabilitation service development in 81 nations in all the world's region. RI provides comphrehensive and varied publications on disability issues, policy, projects and research.
Mobility International USA and the National Clearinghouse on Disability and Exchange provides information and resources on a wide variety of international exchange opportunities for participants with disabilities and international program coordinators. Some staff do not respond to email or phone messages.
Directory of Rural Assistive Technology Resources. The purpose of this directory is to provide a listing of resources, services, agencies, and programs that serve farm and rural families with disabilities.
United Nations economic and social development and disability issues
Disability Awareness in Action
11 Belgrave Road
London SW1V 1RB
Text Tel: +44 171 821 9812
Fax: +44 171 821 9539
Disability Awareness in Action (DAA) is a collaborative project between Disabled Peoples' International, IMPACT, Inclusion International and the World Federation of the Deaf. It is a charitable company limited by guarantee and incorporated in England in January 1992.
CCD Believes in:
Citizenship - Persons with disabilities hold the same rights and responsibilities as other Canadians. Barriers to our participation discriminate against us and must be removed., Self Determination - As full citizens, we assert our right to direct our own lives and make our own decisions. Consumer Control - We must be centrally involved in the decision making processes that affect our lives. Equality - The Charter of Rights and Freedomsguarantees equal benefit and protection of the law and prohibits discrimination based on physical or mental disability. All other legislation must be brouth into line with the Charter.
Veronicas Disability Gopher
St Johns University Rehabilitation gopher server
National Rehabilitation Information Center's ABLEDATA Database
Information on the ABLEDATA Database; Top 10 ABLEDATA Searches; NARIC Fact Sheets; and ABLE INFORM BBS File Areas can be found here.
Some of these NGO"s have web sites but I didn't find the sites very helpful.
Alcida Peréz de Velásquez, M.D.
Regional Advisor in Rehabilitation
Pan American Health Organization
World Health Organization
525 23rd Street, N.W.
Washington, D.C. 20037-2895
Fax (202) 974-3641
PAHO was created in 1902. A regional voice of the World Health Organization (WHO), it promotes and coordinates the efforts of its 38 member-countries throughout Latin America and the Caribbean in combatting diseases and fostering physical and mental health. Note: their web page is not user friendly but I met with Dr. Alcida Peréz de Velásquez and found her to be most helpful regarding CBR books, training manuals, and technical assistance. Dr. Sandra Land was also very helpful with indigenous populations in America.
The ILO, together with UNESCO and WHO, is providing technical support to one CBR programme in Ghana. For further information about the CBR programme there, contact:
Mr. Kumah, CBR Programme Manager
Department of Social Welfare
PO Box M.230
The Ghana programme is also benefitting from support provided by a Norwegian NGO, NAD. For further information about NAD support to CBR programmes in Ghana and other countries please contact:
The Norwegian Association of the Disabled
PO Box 9217 Vaterland
0134 Oslo 1
Specific link to the pages related to CBR are:
(1) CBR reousce materials are at http://www.aifo.it/english/resources/online/books/cbr/cbr.htm
(2) online learning courses about CBR are available on http://www.aifo.it/english/resources/online/courses/online_courses.htm
(3) Asia Pacific Disability and Rehabilitation journal that devotes lot of attention to CBR is on: http://www.aifo.it/english/resources/online/apdrj/journal.htm
AIFO: the full name is 'Amici di Raoul Follereau' and is an italian NGO. It started in 1961, primarily to support Italian missionaries active in the developing countries for helpting leprosy affected persons. In late seventies and early eightees, AIFO decided to become more secular, started collaborating with Governments and international organisations of United Nations. Gradually with availability of better treatment opportunities for leprosy affected persons, the projects supported by AIFO became integrated in primary health care services. At the same time, the projects having rehabilitation services for disabled leprosy affected persons were opened to all persons with a disability. In 1988, AIFO started collaborated with WHO for CBR programs. Note: Dr. Deepak has been very open to sharing information.
WHO is the UN Agency promoting and assisting the inclusion of CBR as part of primary health care. For further information please contact:
Dr Federico Monteiro, Chief (may be retiring soon)
CH 1211 Geneva 27
UNESCO is the UN Agency promoting and assisting the inclusive education of children with special needs in the classroom, and also in a CBR context. For further please see: Inclusive Education
? , Chief
Special Needs Education
Division of Basic Education
7, place de Fontenoy
The ILO is the UN Agency promoting and assisting vocational skills acquisition and work opportunities for youth and adults with disabilities within CBR programmes. To obtain ILO publications email: firstname.lastname@example.org
For ILO related information on CBR, you may wish to contact:
GLADNET, the Global Applied Disability Research and Information Network is an initiative of The Vocational Rehabilitation Branch of the International Labour Organization (ILO), a specialized agency of the United Nations, with headquarters in Geneva, Switzerland. The Vocational Rehabilitation Branch is responsible for promoting the ILO Convention 159 Concerning Vocational Rehabilitation and Employment (Disabled Persons) 1983.
GLADNET has now been constituted as an independent association, with close links to the ILO.
Dr. Maya Thomas
J-124, Ushas Apts
16th Main, 4th Block, Jayanaagar
Bangalore - 560 011 India
Telephone and FAX: 91-80-6633762
Dr. Thomas was formerly working with ActionAid and is now a consultant on planning and management of CBR programs. She is also the Editor of Asia Pacific Disability Rehabilitation Journal.
This link has some good CBR books: http://web.syr.edu/~thechp/multint.htm
The Center on Human Policy (CHP) is a Syracuse University based policy, research, and advocacy organization involved in the national movement to insure the rights of people with disabilities. Since its founding, the Center has been involved in the study and promotion of open settings (inclusive community opportunities) for people with disabilities.
Community Based Rehabilitation.
London: Saunders, 1997, written by Peat, M.
Books available through HealthWrights, 964 Hamilton Ave, Palo Alto, CA 94301 or through the Hesperian Foundation, 1919 Addison St, Suite 304, Berkeley, CA 94704-1144 ...Phone
Disabled Village Children
ISBN 0-942364-06-6 by David Werner
Contains information on common childhood disabilities including polio, cerebral palsy, juvenile arthritis, blindness, and deafness. Provides ideas for rehabilitation at the village level and instructions on how to make low-cost aids.
Helping Health Workers Learn
ISBN 0-942364-14-7 By David Werner and Bill Bower
Indispensable tool for health educators. Provides learning activities for more effective and enjoyable education including theater, drawing, flannel boards, and other low-tech teaching aids.
"Where There Is No Doctor - a village health care handbook"
ISBN 0-942364-01-3 by David. Werner, this book has been translated into 83 languages. Where
There Is No Doctor is perhaps the most widely used health care manual in the developing world. Using simple language and hundreds of drawings, the book provides information about recognizing, treating, and preventing common illnesses and injuries.
Nothing About Us Without Us
by David Werner. Developing Innovative Technologies For, By and With Disabled Persons. Utilizes disabled persons as leaders in the problem-solving process. Our objective is not to catalogue a set of aids and equipment to be copied, but to share an EMPOWERING PROBLEM-SOLVING APPROACH. I have this book and highly recommend it to anyone working on appropriate technology in developing countries.
Questioning the Solution
by David Werner and David Sanders. Questioning the Solution analyzes why 13 million children still die every year from preventable causes, and challenges conventional Primary Health Care and Child Survival strategies. Too often, health and development planners try to use technological fixes rather than confront the social and economic inequities that perpetuate poverty, poor health, and high child mortality.
"Prejudice and Dignity" by E.Helander This book introduces readers to the concept and experience of community-based rehabilitation (CBR), Published by: United Nations Development Programme, Division for Global and Interregional Programmes New York 1993..Phone the UN bookstore 212-963-7680. Dr Helander is the head of the Interregional Programme for Disabled People of the United Nations Development Programme.
"Sharing Opportunities - A Guide to Disabled People's Participation in Sustainable Human Development" by E. Helander. Published by: United Nations Development Programme Disability Action Group Geneva 1996
Essential CBR Information Resources
This book lists 118 resources, including books, articles, manuals, reports and videos. It contains a brief description of their contents and how to obtain them. It is available for $10 US from AHRTAG (see web sites)
Disability and Self-directed Employment: Business Development Models
A. Neufeldt and A. Albright, Eds. (1998)
The idea of wage employment as the only real goal for disabled people is starting to be challenged by another idea -- self-directed employment. In low-income countries there has never been many options due to low wage scales. With relatively little access to salaried employment, and the only real safety net being one's family, other means of income generation have been important for the survival of significantly disabled people. In high- income countries, however, the situation has been different. For a variety of reasons, policies related to the employment of disabled people have focused almost exclusively on issues relevant to accessing wage employment; as has the attention of organizations concerned with disabled persons. Only within the past few years are we beginning to see increasing interest in self-employment, and other entrepreneurial options where disabled people may be in the lead role.
This book is organized into three sections. The first section summarizes the current state of knowledge on the experience of disabled people in accessing employment, and the particular role of self-employment. The second has chapters by researchers from different world regions, with examples of the kinds of initiatives discovered. The third analyzes the information that was gathered and concludes the study.
The book is available from : Captus Press Inc., York University Campus
4700 Keele Street
North York, ON, Canada, M3J 1P3
Phone: Fax: (416) 736-5793
Email: Bob@captus.com Internet: http://www.captus.com
Books and manuals available through TALC
Available (in ENGLISH unless otherwise stated) from:
Teaching-Aids At Low Cost (TALC)
PO Box 49, St Albans, Herts AL1 5TX, UK.
Telephone +44 1727 853869
Fax +44 1727 846852
Women and HIV/AIDS: an international resource book
Covers many issues concerning women, HIV/AIDS, reproductive health and sexual relationships. Includes resources and contacts.
English: 400 pages, 1993, ISBN 0 04 440876 5
Spanish:400 pages, 1993, ISBN 0 9522417 0 6
How to Make Simple Disability Aids
Shows how to make low-cost aids for people with disabilities from locally available materials.
76 pages, 1987
Personal Transport for Disabled People
Shows successful designs for local manufacture of wheeled aids, including wheelchairs, trolleys and tricycles, made up and tested by disabled people in India, Kenya, Zimbabwe and Malawi.
88 pages, 1984
How to Manage a Health Centre Store
Provides guidelines for running a health centre medical store, including ordering and storing essential drugs and supplies.
72 pages, 1994 (revised), ISBN 0 907320 25 2
Other assorted CBR books
These books are very hard to find. I ordered the first one, anyone have the others ?
The Handicapped Community : The Relation Between Primary Health Care and Community Based Rehabilitation (Primary Health Care Publications, Vol 7, by Harry Finkenflugel (Editor) Publication date: April 1994
Rehabilitation/ Restorative Care in the Community
Community Rehabilitation Services for People with Disabilities
Publisher Butterworth-Heinemann, US
Community-based Rehabilitation and the Health Care Referral Services
Community Based Rehabilitation
Publisher WB Saunders
Practical Social Research : Project Work in the Community
Publisher Macmillan P
Across Borders: Women with Disabilities Working Together.
The publisher is Gynergy Books in Canada.
Innovations in Developing Countries for People with Disabilities
Brain O'Toole and Roy McConkey (eds). Paul H. Brookes
Publishing, Baltimore. ISBN: 1-870335-18-X
I understand that the City University of Hong Kong, the University of Manchester in the UK, Queen's University in Kingston, Ontario, Canada, the University of Sydney in Australia and Auburn University in Alabama all have CBR programs or courses.
Harry Finkenflugel was kind enough to let us post his PhD thesis on the CBR Resources web page. If you would like a hard copy, please contact Harry directly at email@example.com For a digital copy click Thesis
|Erasmus Medisch Centrum
Instituut Beleid en Management Gezondheidszorg
3000 DR Rotterdam
|Erasmus Medical Center
Institute for Health Care Policy and Management
P.O. Box 1738
3000 DR Rotterdam
tel ... 31 10 408 9701
From the UN
"Community-based rehabilitation (CBR) is a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights. It calls for the full and co-ordinated involvement of all levels of society: community, intermediate and national. It seeks the integration of the interventions of all relevant sectors - educational, health, legislative, social and vocational - and aims at the full representation and empowerment of disabled people. It also aims at promoting such interventions in the general systems of society, as well as adaptations of the physical and psychological environment that will facilitate the social integration and the self-actualisation of disabled people. Its goal is to bring about a change; to develop a system capable of reaching all disabled people in need and to educate and involve governments and the public. CBR should be sustained in each country by using a level of resources that is realistic and maintainable.
At the community level, CBR is seen as a component of an integrated community development programme. It should be based on decisions taken by its members. It will rely as much as possible on the mobilisation of local resources. The family of the disabled person is the most important resource. Its skills and knowledge should be promoted by adequate training and supervision, using a technology closely related to local experience. The community should support the basic necessities of life and help the families who carry out rehabilitation at home. It should further open up all local opportunities for education, functional and vocational training, jobs, etc. The community needs to protect its disabled members to ensure that they are not deprived of their human rights. Disabled community members and their families should be involved in all discussions and decisions regarding services and opportunities provided for them. The community will need to select one or more of its members to undergo training in order to implement the programme. A community structure (committee) should be set up to provide the local management.
At the intermediate level, a network of professional support services should be provided by the government. Its personnel should be involved in the training and technical supervision of community personnel, should provide services and managerial support, and should liaise with referral services.
Referral services are needed to receive those disabled people who need more specialised interventions than the community can provide. The CBR system should seek to draw on the resources available both in the governmental and non-governmental sectors.
At the national level, CBR seeks the involvement of the government in the leading managerial role. This concerns planning, implementing, co-ordinating, and evaluating the CBR system. This should be done in co-operation with the communities, the intermediate level and the non-governmental sector, including organisations of disabled people." ("Prejudice and Dignity", E.Helander, p.8).
Dr Helander now works for the UN Development Programme's Interregional Programme for Disabled People, based in Geneva.
Community based rehabilitation (CBR) is a response, in both developed and developing countries, to the need for adequate and appropriate rehabilitation services, to be available to a greater proportion of the disabled population. Its aims are to rehabilitate and train disabled individuals, as well as to find ways to integrate them into their communities. In CBR, the disabled person, the family, the community, and health professionals collaborate to provide needed services in a non-institutional setting, and in an environment or community where services for disabled persons are seriously limited or totally absent. Its esssential feature is its focus on partnership and community participation. Approaches to the implementation of CBR are many and are determined by a variety of social and demographic factors. Introducing rehabilitation services at a local or community level removes many obstacles to care which are associated with institutions. The difficulty of travel and its expense are eliminated or reduced to a minimum. The individual is not isolated from the community; family members and community volunteers are part of the rehabilitative process. All participants can see what the disabled person has achieved. This can help integrate the person into the community, a community which values the unique contribution which the person is able to make.
In developed countries, the CBR model responds to the shift away from institutional care to home-based care, and to health-care restructuring in light of reduced funding. In the developing world, CBR provides the focus for training a new corps of health and social personnel. In conflict and post-conflict regions, CBR is being implemented to provide essential rehabilitation services to a population ravaged by war.
Lysack, C, Kaufert, J (1994). Comparing the origins and ideologies of the independent movement and community based rehabilitation. International Journal of Rehabilitation Research. v17, n3, pp 231-240.
Joint position paper by ILO, UNESCO and WHO called Community Based Rehabilitation, CBR, for and with people with disabilities, issued in 1994