• All the Activities that disabled people, their family members and community members do in their community for disabled persons such as general care, adaptation of family members to disabled, education, health etc using whatever they know, whatever they have, in whatever circumstances

• ‘A Concept and an Ideology'

• CBR promotes decentralized approach to service delivery

• It is based on the assumption that community members are willing and able to mobilize local resources and provide appropriate services to disabled people. This concept was tried in many CBR programmes in developing world by using governmental machinery but has remained as an ideology and proved unrealistic in most cases.

• Recognizing human and material resources limitations of disabled people, their family members and other community members, a CBR programme tries to promote and facilitate CBR

• How?

• By visiting disabled and their families in their home, providing information, training, therapy, promoting their rights

• Disadvantage- CBR Programmes consider local culture as an obstacle rather than facilitator

Medical Model:

• Followed by Institutes i.e. Institutional Based Rehabilitation (IBR)

• Usually from Centre/ Outreach/ Mobile/Camp

• Service providers only concentrate on medical problems -look at the eyes, hands or legs

• Prescribe, occasionally intervenes and consider medical rehabilitation is the only answer-RELATIONSHIP OFTEN GIVER & TAKER

Medical + Social Model :

• Community and persons with disabilities (PWD) are major resource

• More democratic- PWD are principal decision makers

• Reflects rights perspective rather than typical charity

• Rehabilitation takes place at the doorstep of PWD

• Social inclusion more important than medical rehabilitation

• Early Intervention+ Regular Follow Up+ Total Rehabilitation

Figure 1

Table 1: Different Approaches to Rehabilitation

• Home based

• Less expensive

• Existing community responses and resources

• Focus on quality rather than quantity

• Multiple approaches based on community needs

• Different priorities in poor- Survival needs has more priorities than solving problems of disabled. CBR programme should therefore be focusing on essential needs.

• Complex Organization-

• Low field activity- Educated workers rarely go to field and also find hard to communicate with low educated disabled people.

• Low Social status to CBR worker- Frontline CBR is low profile job so less educated workers may influence quality of services provided

• Lack of community ownership- Breakdown of traditional social structure that contribute to several problems

• Expensive approach- as focus on quality (few hardcore patients)

• Hard Work- It involves visiting individuals and family at home, identifying problems and providing care and guidance, and follow up of patients

• Not easily measurable and quantifiable- How do we know if a school lesson given by CRW is the reason why former school girl will come to eye clinic when she gets cataract at age of 50 years

Build on

• Widespread and existing resources of community

• Ideas and skills which are existing in minds of family members, community and disabled

• Has inbuilt community level programmes

• Part of national agenda in dealing with disability

• Training to general MPW in rehabilitation

• Coordination between various H&FW programmes

• Hospital to add CBR component to their outreach services

• Professional and political commitment

Therefore in summary, for a good CBR PROGRAMME, SMALL existing community input (knowledge and skills )should lead to LARGE output (application and energy)