Community Services: Community-based Rehabilitation

E. Community Services: Community-based Rehabilitation

1. The Role of the Family in the Community-based Rehabilitation Process

Sector: Community-based rehabilitation (CBR)

Goal:

Management for social action

KIPA Focus:

Knowledge and participation

Country: India

Participating agencies:

Spastics Society of Tamil Nadu (SPASTN)

Beneficiaries:

People with disabilities and the community

39. Background: A woman abandoned by her husband, Mrs. Gajalakshmi has three daughters and her youngest daughter, Anusuya, now aged 12 years, is a severe quadriplegic child. She took Anusuya to SPASTN and out of her interest in the activities learnt all the therapy activities and speech interventions needed to help her child. As a result, she now runs the services at the center and educates other parents on their children’s rehabilitation needs.

40. Strategy: Mrs. Gajalakshmi helped a visiting CBR team in forming a self-help group of 18 women with disabilities from her village. She gave her own land for collective income-generation activities and put up a small hut there with community contributions. Through the self-help group she takes up social causes to the village leaders about the concerns of people with disabilities. As a remarkable milestone, Mrs. Gajalakshmi stood for the ward member post in the local elections, nominated by the village panchayat leader himself. In an ironic twist, her husband became blind from drinking toxic liquor. Mrs. Gajalakshmi took him back and he is now fully dependent on her. In spite of now having to look after two people with disabilities in her own house, she runs the local SPASTN center and continues to be a role model to everyone with disabled family members.

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Results: Mrs. Gajalakshmi’s valuable contribution is in knowledge, promoting low-cost rehabilitation aids and appliances made of mud, bricks, clay, plantain barks, etc. This has helped most of the parents in rural areas to participate by following up programs at home to maintain the functional position required by their children.

2. CBR Mainstreaming in Primary Health Care, Bosnia-Herzegovina

Sector: Community-based rehabilitation

Goals:

Functional independence, environmental awareness, and management for social action

KIPA Focus:

Access, knowledge, inclusion, and participation Country: Bosnia-Herzegovina

Participating agencies:

Ministries of health, Federation of Bosnia-Herzegovina and Republika Srpska, the World Bank, International Centre for the Advancement of Community Based Rehabilitation (ICACBR)

Beneficiaries:

People with disabilities and the community

41. Background: Bosnia-Herzegovina experienced 4 years of conflict in which more than 200,000 lives were lost and more than 50,000 persons were injured and disabled, including 5,000 persons who lost a limb. During the conflict, CBR services and strategies were introduced and established by ICACBR in collaboration with the Ministry of Health and WHO. In November 1995, the Dayton Peace Accord was signed and the process of postconflict reconciliation, rehabilitation, and reconstruction began. The Government and the World Bank identified disability and the need for quality services as a priority for the national reform of its rehabilitation system within the health sector.

42. Goal: The overall goal was to help people with disabilities return to economically productive and social lives in their communities by restoring and improving the quality and scope of rehabilitation services delivered as part of the health care system.

43. Strategy: CBR was determined to be the core component in a continuum of prosthetic/orthotic and essential hospital rehabilitation services. The World Bank and other donors supported the civil works and reconstruction of existing primary health care, hospital, and CBR centers. ICACBR led the project design, policy development, clinical and management education of CBR personnel, and research. The Government was responsible for taking ownership of the CBR centers and establishing the legislation for financing them, including salaries for more than 400 personnel.

44. Output: By 2003, there was a network of 42 CBR centers in rural and urban communities serving more than 40,000 people with disabilities and their families annually, regardless of physical disability, geographic location, ethnic origin, age, and sex. In addition, ICACBR is now collaborating with the Government of Japan and the Ministry of Health to make CBR a truly national program by establishing 17 new CBR centers using the model already introduced.

45. Outcomes: Access and knowledge. The project made rehabilitation services accessible in rural and urban communities. Inclusion. CBR is a core element of the primary care system as a publicly funded program. Participation. People with disabilities have become increasingly formally involved in decision making related to project design

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and policy reform in the Federation and increasingly expected to participate in social reform. The project has ensured that a core component of the program involves people with disabilities as decision makers and participants in project activities.