Community Based Rehabilitation

Enablement understands Community Based Rehabilitation (CBR) as a strategy that aims to improve the quality of life of persons with disabilities. This strategy involves working closely with persons with disabilities, their families, and stakeholders at the local, national and international level.

These stakeholders can be community leaders (such as chiefs), religious leaders, school boards, neighbours, sports clubs, and not to miss: local and national governments. Together with all these actors we work to include persons with disabilities in every domain of community life. 

CBR is usually conducted in natural community settings, such as at a person with a disabilities’ homes rather than in a formal delivery settings such as hospitals or center-based environments.

Greater collaboration with the community and empowerment of the support network of people with disabilities and services surrounding the person with a disability is possible in a CBR model thus enabling the person with a disability to make sustainable gains. For example, family members may be involved in rehabilitation sessions for the purposes of education, livelihood, social participation and empowerment. Furthermore, collaboration with others (work colleagues, friends, and paid support workers) who may be in a position to help the person with a disability to achieve their goals, is also possible in a CBR model.

The principles of CBR

The CBR Guideline of WHO refers to 10 principles in total of which 8 form major principles of the UNCRPD. In Monitoring and Evaluation Enablement puts the main emphasis on 3 principles, as Enablement believes that all can be incorporated within these 3 essential principles:

• Empowerment - happens when individuals or groups of people recognize that they alone can change their situation and then begin to do so. To succeed, they may need support from family, community or civil society. How does the program plan for this? Do people with disabilities have influence on their life situations? Are Disabled People’s Organisations/community groups involved in decision-making processes in their communities?
• Inclusion - how does the program enable persons with disabilities to participate in mainstream institutions in each of the 5 domains of the WHO CBR Guidelines? In what way is a multi-sectoral approach incorporated to achieve true inclusion?
• Sustainability - how is the program embedded in the surrounding community and how does it draw on local resources? Is the organization able to adapt to changing circumstances?

Evolving developments

CBR was initiated by the WHO in 1978. Its objective is to improve access to rehabilitation services for people with disabilities in low- and middle-income countries, by making use of resources within the country. Over the past 33 years, CBR has evolved into a multi-sectoral strategy addressing the various needs of persons with disabilities, ensuring their participation and inclusion in society which enhances their quality of life. CBR ensures that persons with disabilities and their families benefit from the health, education, livelihood and social sectors.

The exact nature of CBR services depends on the needs of the persons with a disability within their setting, such as the presence of disability support, environmental resources including availability of disability supports, the availability of skills and expertise, feasibility and availability of funding

Disability Inclusive Development

Disability-inclusive development (DID) is an approach, which particularly focuses on the rights and inclusion of people with disabilities. It actively seeks to ensure the full participation of people with disabilities as empowered self-advocates in all development processes and emergency responses. Also, it works to address the barriers which hinder access and participation of people with disabilities...

Relation between CBR and DID

Enablement sees CBR and DID as two roads leading to the same goal: realising societies in which people with disabilities like any other person - regardless of age, gender, ethnicity, race, class, religion, sexuality or any other characteristic - participate fully and are enabled to reach their full potential. Our documentary CBR for Inclusive Development gives a clear picture of how we see the reality of CBR and disability inclusive development in the field.

More information on CBR see:
World Health Organisation

How does M&E affect CBR?

Monitoring and Evaluation are processes to improve CBR practices and with that the quality of life of people with disabilities. M&E according to Enablement’s vision should be done by both desk study and field visits and includes the following aspects:

• Context analysis of policy state factors & eco-social factors
• Stakeholder analysis
• Intervention logic mirroring the three principles
• Terms of Reference based on critical dialogue with stakeholders
• Fieldwork using methods adapted to the context, both quantitative and qualitative and always participative and culturally sensitive.
• Reporting and debriefing with clear recommendations
• Methodology.

We believe evaluations are necessary to improve CBR practices and to enable stakeholders to learn from it. Therefore, we discuss with stakeholders at all levels and use an approach in which we help them to reflect on their activities. In this process Enablement operates with respect towards the people involved. In evaluating CBR projects, Enablement uses the ToR, the main topics and questions of the organisation and the three principles inclusion, empowerment and sustainability.

Read more about Enablement’s expertise in M&E.

---