The starting point for understanding CBR is the following approach agreed to in 1994 by ILO, UNESCO and WHO:
‘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.’
LINK TO THE MILLENIUM DEVELOPMENT GOALS (up to 2015)
Goal 1: Eradicating extreme poverty and hunger
Poverty is both a cause and consequence of disability. People with disabilities face stigma and discrimination in their communities and are frequently denied their basic rights such as food, education, employment and access to health services. People with disabilities may incur extra costs, such as those related to healthcare, and they are less likely to work. CBR promotes livelihoods and employment by:
• Identifying and overcoming barriers that prevent participation.
• Exploring potential employment opportunities for people with disabilities in their communities.
• Providing or ensuring access to skills training for income-generating activities and employment.
Goal 2: Achieving universal primary education
Estimates of the percentage of children with disabilities not attending school is extremely variable, however, in general, children with disabilities are less likely to start school and have lower rates of staying and being promoted in school than their peers without disabilities (1). The correlation between low educational outcomes and having a disability is often stronger than the correlations between low education outcome and other characteristics such as gender, rural residence or poverty (1). CBR supports inclusive education by:
• Informing families with disabled children that they have a right to access educational opportunities.
• Providing recommendations and practical assistance to make school environments physically accessible and teaching flexible and childcentered.
• Referral of children to specialized services to enable their inclusion in primary education, for example, referral for assistive devices.
Goal 3: Promoting gender equality and empowering women
Many women with disabilities face discrimination based on both their gender and disability. Women with disabilities are likely to be denied access to education and employment opportunities and are at increased risk of violence and abuse. For those women who care for family members with disabilities, they may face significant hardships particularly where there are limited support services. CBR supports gender equality and empowerment of women by:
• Promoting equal access and participation for women with disabilities in all community development initiatives.
• Supporting girls with disabilities to access educational opportunities.
• Supporting the development of self-help groups for women with disabled children.
Goal 4: Reducing child mortality
Mortality rates for children with disabilities are difficult to estimate, however, it has been suggested that they may be as high as 80% in countries where under-five mortality as a whole has decreased to below 20% (2). Children with disabilities are more at risk of dying, not only because of life threatening medical conditions or lack of access to health services, but also because in many cultures they are neglected or left to die (3). CBR programmes can contribute to reducing child mortality by:
• Ensuring early identification of children with impairments and referral of children to specialized medical and rehabilitation services where required.
• Providing disability awareness training to primary health care staff to ensure children with disabilities are able to access general health care.
• Providing basic home-based therapy interventions to promote child development.
Goal 5: Improving maternal health
Millions of women experience morbidity and disability as a result of pregnancy and childbirth complications. At the same time, women with disabilities can also become mothers themselves, and sometimes need particular consideration during pregnancy or when bringing up children.
CBR can contribute to the improvement of maternal health by:
• Raising awareness within communities that people with disabilities have sexual and reproductive health needs.
• Supporting women with disabilities to access maternal health services in their communities.
• Ensuring traditional birth attendant training programmes have a focus on disability.
Goal 6: Combat HIV/AIDS, malaria, and other diseases
Infectious diseases are disabling; for example, HIV can cause blindness, neuropathy and dementia. At the same time people with disabilities also have as high or higher risk of contracting HIV. Research conducted in Mozambique on disability and HIV found that one reason people with disabilities are routinely excluded from HIV and AIDS policies and programmes is a refusal or reluctance to acknowledge their sexuality (4). CBR can contribute to combating disease by:
• Reducing the stigma surrounding sexuality and people with disabilities.
• Promoting the provision of health information to be available in accessible formats.
• Developing tailored prevention programmes for people with disabilities where mainstream programmes are inappropriate and ineffective.
Goal 7: Ensure environmental sustainability
Environmental risks, such as poor sanitation and water quality, and natural disasters can cause ill health and disability. Many people with disabilities face barriers in accessing community facilities such as wells and latrines and they are often excluded from disaster management activities. CBR contributes to environmental sustainability by:
• Ensuring communities involve people with disabilities when designing safe water and sanitation facilities.
• Making recommendations and modifications to ensure access to existing facilities.
• Ensuring disaster response training within communities considers the needs of people with disabilities and appropriate strategies are in place.
Goal 8: Develop a global partnership for development
CBR is a partnership approach, and works with all development sectors to achieve positive outcomes for people with disabilities. The International Disability and Development Consortium (IDDC) and 3 CBR global alliances – CBR Asia-Pacific Network, CBR Africa Network, and the CBR American and Caribbean Network – work to promote CBR and inclusive development. CBR contributes to global partnerships for development by:
• Networking with government sectors, NGOs (local, national and international) and communities.
• Promoting CBR as a strategy for mainstreaming disability across all development sectors.