The principles of CBR are based on the principles of the CRPD.

[2] The
principles are:

 Respect for inherent dignity, individual autonomy including the freedom

to make one’s own choices, and independence of persons
 Non-discrimination
 Full and effective participation and inclusion in society
 Respect for difference and acceptance of persons with disabilities as part of
human diversity and humanity
 Equality of opportunity
 Accessibility
 Equality between men and women
 Respect for the evolving capacities of children with disabilities and respect
for the right of children with disabilities to preserve their identities.
 SUSTAINABILITTY

 INCLUSION

 SELF ADVOCACY

 PARTICIPATION

 EMPOWERMENT

 BARRIER FREE ENVIRONMENT

This publication focuses on understanding community-based

rehabilitation (CBR). It does not try to define CBR, as it has
become apparent in recent years that CBR defies definition. This
is because its simplicity and complexity have led to confusion
about what CBR means. The simplicity of CBR has to do with its
history of starting with the delivery of primary rehabilitation
therapy to people with disabilities in their communities (1). The
complexity of CBR is the result of the current concept that CBR
programmes should be multi-sectoral (or multi-disciplinary) so
that they can provide assistance in all of the areas which are
central to improvement of the quality of life of people with
disabilities. This complexity recognizes the need for close
coordination, collaboration and cooperation between
governmental and non-governmental organizations of all types
and at all levels.

The basic concept inherent in the multi-sectoral approach to CBR

is the decentralization of responsibility and resources, both
human and financial, to community-level organizations. In this
approach, governmental and non-governmental institutional and
outreach rehabilitation services must support community
initiatives and organizations.

For the multi-sectoral approach to CBR to be successfully

translated into action, both governmental and non-governmental
service capacities need to be improved in most countries of the
Asian and Pacific region. Of special importance is improvement of
the capacity and skills for facilitating community involvement.
Such improvement and related activities must be closely
coordinated to ensure the optimum use of scarce resources. In
accordance with the multi-sectoral concept, systems are
developed, at the community level and among governmental and
non-governmental organizations, that interact and reach out to
each other.

Another factor for the success of the multi-sectoral approach is

the empowerment of the community to assume responsibility for
ensuring that all its members, including those with disabilities,
achieve equal access to all of the resources that are available to
that community, and that they are enabled to participate fully in
the social, economic and political life of the community. This
approach ensures that what is done in the name of CBR actually
fits into the reality of the community and is owned by the
community.

THE MULTI-SECTORAL APPROACH

The starting point for understanding CBR is the following

approach agreed to in 1994 by ILO, UNESCO and WHO(2):

Community-based rehabilitation (CBR) is 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.

This approach to CBR is multi-sectoral and includes all

governmental and non-governmental services that provide
assistance to communities. Many of the services which can
provide opportunities for and assistance to people with disabilities
are not traditionally considered relevant to CBR programmes and
people with disabilities. Examples include community
development organizations, agricultural extension services, and
water and sanitation programmes.
In the ILO-UNESCO-WHO approach to CBR, the phrase "within
community development" is understood to be the following
strategy recommended by the United Nations(3):
 ... the utilization, [in an integrated programme](4), of
approaches and techniques which rely on local communities as
units of action and which attempt to combine outside
assistance with organized local self-determination and effort,
and which correspondingly seek to stimulate local initiative and
leadership as the primary instrument of change.

In the CBR context, community means: (a) a group of people with

common interests who interact with each other on a regular
basis; and/or (b) a geographical, social or government
administrative unit.

PROGRAMME CRITERIA

The development and implementation of CBR programmes should

be based on the following criteria:
1. People with disabilities must be included in CBR
programmes at all stages and levels, including initial
programme design and implementation. In order to give
significance to their involvement, they must have distinct
decision-making roles.

2. The primary objective of CBR programme activities is the

improvement of the quality of life of people with
disabilities.

3. One focus of CBR programme activities is working with the

community to create positive attitudes towards people with
disabilities and to motivate community members to support
and participate in CBR activities.
4. The other focus of CBR programmes is providing assistance
for people with all types of disabilities (physical, sensory,
psychological and mental); for people of all ages, including
older people; for people affected by leprosy; for people
affected by epilepsy; and for other people who may be
identified by the community as needing special assistance.

5. All activities in CBR programmes must be sensitive to the

situation of girls and women. This is because in many
communities throughout the Asian and Pacific region
women are not treated equally. When they are disabled,
the problems that they face in life are doubled.
Furthermore, women are usually the primary family care-
givers for all people with disabilities.

6. CBR programmes must be flexible so that they can operate

at the local level and within the context of local conditions.
There should not be only one model of CBR because
different social and economic contexts and different needs
of individual communities will require different solutions.
Flexible, local programmes will ensure community
involvement and result in a variety of programme models
which are appropriate for different places.

7. CBR programmes must coordinate service delivery at the

local level. Community members seldom understand the
different roles and specializations that are part of providing
assistance to people with disabilities. They tend only to see
the problem of disability and only to want access to "one
window" for help. They may focus only on where to go and
who to see about a specific "problem", rather than
understanding the totality of what constitutes a fulfilling life
for a community member who has a disability.
 THE COMPONENTS OF COMMUNITY-BASED
REHABILITATION PROGRAMMES

The components of a CBR programme should include:

1. Creating a positive attitude towards people with
disabilities: this component of CBR programmes is
essential to ensure equalization of opportunities for people
with disabilities within their own community. Positive
attitudes among community members can be created by
involving them in the process of programme design and
implementation, and by transferring knowledge about
disability issues to community members.

2. Provision of functional rehabilitation services: often

people with disabilities require assistance to overcome or
minimize the effects of their functional limitations
(disabilities). In communities where professional services
are not accessible or available, CBR workers should be
trained to provide primary rehabilitation therapy in the
following areas of rehabilitation:
o Medical
o Eye care service
o Hearing services
o Physiotherapy
o Occupational therapy
o Orientation and mobility training
o Speech therapy
o Psychological counselling
o Orthotics and prosthetics
o Other devices
3. Provision of education and training
opportunities: people with disabilities must have equal
access to educational opportunities and to training that will
enable them to make the best use of the opportunities that
occur in their lives. In communities where professional
services are not accessible or available, CBR workers
should be trained to provide basic levels of service in the
following areas:
o Early childhood intervention and referral, especially
to medical rehabilitation services
o Education in regular schools
o Non-formal education where regular schooling is not
available
o Special education in regular or special schools
o Sign language training
o Braille training
o Training in daily living skills

4. Creation of micro and macro income-generation

opportunities: people with disabilities need access to
micro and macro income-generation activities, including
obtaining financial credit through existing systems,
wherever possible. In slums and rural areas, income-
generation activities should focus on locally appropriate
vocational skills. Training in these skills is best conducted
by community members who, with minimal assistance, can
easily transfer their skills and knowledge to people with
disabilities.

5. Provision of care facilities: often, people with extensive

disabilities are in need of assistance. When they have no
families or their families are incapable of caring for them, in
order for them to survive, long-term care facilities must be
 provided in the community where they can get the
assistance that they need. Moreover, day-care facilities
may be needed to provide respite for families who either
work or need time off for other activities.

6. Prevention of the causes of disabilities: many types of

disability can be prevented by relatively simple measures.
Proper nutrition is one of the more significant ways of
preventing disabilities. Another important area of disability
prevention is the detection of disability in young children
and intervention early in their development, to minimize
the effect of impairment. There are many other areas of
disability prevention that are also important. These include
activities to decrease the number of accidents in the home,
on the road and at work, as well as other initiatives to
encourage people to pursue healthy lifestyles over the
course of their lives.

7. Management, monitoring and evaluation: the

effectiveness and efficiency of all CBR programme
components, both in the community and in the area of
service delivery outside the community, depend on
effective management practices. The impact of programme
activities must be measured on a regular basis. People
must be trained in effective management practices. Data
must be collected, reviewed and evaluated to ensure that
programme objectives are met. In this way, the success or
failure of a CBR programme can be honestly measured.

SECTORS AND ROLES FOR THE DEVELOPMENT AND

IMPLEMENTATION OF COMMUNITY-BASED
REHABILITATION
The initiative to start CBR programmes and to facilitate their
development may come from any one of the following groups.
However, the effectiveness of CBR and the long-term
development and sustainability of any CBR initiative will require
the coordination, involvement and collaboration of all seven
groups. The seven groups and their suggested roles are as
follows:
1. People with disabilities: People with disabilities can and
should contribute to all levels of CBR programmes in every
position within a programme. They know what the effects
of local conditions are on themselves. They are likely to
have a good understanding of those effects on their peers
with disabilities. They also know what impairment really
means in the context of their family, community and
nation. This knowledge enables them to be very effective
members of a CBR team. They can be more effective than
non-disabled people as role models for and counsellors of
other people with disabilities. People with disabilities have
an important role in community education. As community
educators, they serve as living examples of people with
disabilities who make a significant contribution, provided
that they are given the opportunity and the right type of
assistance. CBR programmes should also facilitate the
development of self-help organizations of people with
disabilities at the community level.

2. Families of people with disabilities: families have the

primary responsibility for caring for all of their members.
They are the first line of support and assistance for people
with disabilities at the local level. As such, families must be
included in CBR programme activities. Where the individual
with a disability is not able, for whatever reason, to speak
 for himself or herself, a family member should represent
him or her and should be considered a legitimate member
of disabled people's organizations. Members of families
with experience in caring for people with disabilities are the
people who most often initiate CBR programmes and are,
or prove to be, the most effective contributors at all levels.

3. Communities: community members should be involved in

CBR programmes at all levels because they already know
the local environmental conditions, the local economy, the
local political situation and how to work with them. They
also know about the accessibility, availability and
effectiveness of locally available rehabilitation services;
who in the community cares enough about other people to
become a programme leader or worker; and, which
community members have the knowledge and skills for
training others in micro-economic activities. They are the
people most likely to want to live, work and stay in the
community. Community involvement usually requires the
agreement and approval, both formal and informal, of the
community leaders.

4. Governments (local, regional, national): governments

have the most important role in the development and
sustainability of CBR programmes. Their cooperation,
support and involvement are essential if CBR is to cover the
total population and be sustainable. They should implement
and coordinate the development of the entire programme
structure, including the development of the referral system,
as well as the activities within the community. They also
should provide resources for non-governmental
organizations (NGOs) and community activities. Finally,
they should ensure that discriminatory legislation is
 changed and that the rights of people with disabilities are
guaranteed and protected.

5. Non-governmental organizations, local, regional,

national and international organizations: NGOs,
including organizations of people with disabilities, are often
able to provide resources and skills to facilitate the
development of new programmes, especially in areas
where none exist. They can develop new approaches to
CBR and provide training programmes for government
employees, CBR workers, people with disabilities, families,
and community members. NGOs are effective in facilitating
the development of community members as CBR
programme leaders. They are often best able to provide
long-term care facilities for those people with extensive
disabilities whose families cannot or will not look after
them.

6. Medical professionals, allied health science

professionals, educators, social scientists and other
professionals: professionals are often in a position where
they can, as trainers and educators, facilitate the
development of new programmes by making their
knowledge and skills accessible to community members
and CBR programme workers. They can also ensure that
they support community efforts by making themselves
available and accessible on a referral basis. When they are
in government service, they can advocate and promote the
development of CBR programmes as an effective way to
provide local-level services quickly.

7. The private sector (business and industry): the private

sector has a social obligation to return some of the benefits
of its operations to the communities that support it. In the
 past, this support has largely taken the form of charity.
Charity occurs when donors "give" whatever they feel is
needed or appropriate to people with disabilities. This
approach to assisting people with disabilities is no longer
appropriate and needs to be changed. Supporting CBR
programme activities eliminates the need for charity. CBR
support is a much more appropriate way of directing
resources to communities and people with disabilities. By
supporting CBR programmes, the private sector receives
credit for its social involvement while being guaranteed
that its support is put to effective and efficient use. Who
but trained, knowledgeable community members would
know what is most needed by the people of their own
community?

SUMMARY

In recent years a multi-sectoral (or multi-disciplinary) concept of

CBR has evolved. That concept emphasizes working with and
through the community to create positive attitudes towards
people with disabilities, to provide assistance to people with
disabilities and to make the necessary changes to the
environment and service delivery systems.

In response to this conceptual change, CBR is now defined as a

community development programme that has seven different
components:

(i) Creation of a positive attitude towards people with

disabilities;
 (ii) Provision of rehabilitation services;

(iii) Provision of education and training opportunities;

(iv) Creation of micro and macro income-generation

opportunities;

(v) Provision of care facilities;

(vi) Prevention of the causes of disabilities;

(vii) Monitoring and evaluation.

The resources, skills and initiatives to start and sustain CBR

programmes require the cooperation and collaboration of seven
relevant sectors:

(i) People with disabilities

(ii) Families of people with disabilities;

(iii) Communities;

(iv) Governments (local, regional, national, international);

(v) NGOs, local, regional, national and international

organizations, and organizations of people with disabilities;

(vi) Medical professionals, allied health science professionals,

educators, social scientists and other professionals;

(vii) The private sector (business and industry).

foot notes
*
Prepared by the Working Group on CBR of the Regional Inter-
agency Committee for Asia and the Pacific (RICAP) Subcommittee
on Disability-related Concerns. ESCAP serves as the secretariat of
the Subcommittee. All members of the Subcommittee contributed
to the preparation of the document. The Subcommittee, at its
fourteenth session in May 1997, finalized and adopted the
document to mark the mid-point (1997) of the Asian and Pacific
Decade of Disabled Persons, 1993-2002.
1. The Alma Ata Declaration of Health for All and its emphasis on
primary health care included services for people with disabilities.
It is this concept that led to the development of the first models
of CBR which emphasized delivery of primary rehabilitation
therapy in the community.
2.Community-Based Rehabilitation for and with People with
Disabilities, 1994 Joint Position Paper, International Labour
Organization (ILO), United Nations Educational, Scientific and
Cultural Organization (UNESCO) and World Health Organization
(WHO).
3. See document E/CN 5/291.
4. The original definition has been changed from "under one
programme" to "in an integrated programme".