Health, Rehabilitation and Support Services
Dr. Bishnu Maya Dhungana
Independent Consultant (Disability Development), Nepal
Achievements
Recommendations
CBR Programmes and support services have been popular in most
developing countries due to following reasons:
 CBR works with health sectors, providing basic health services,
making people clear about causes & prevention of disability,
providing assistive devices and rehabilitation services based on
individual needs
 CBR Programme is providing mobility training, daily living skills,
helping persons with disability come out of their houses, help
them to build social network among themselves and beyond
 CBR Programmes have been increasing public awareness at all
levels by different means: conducting workshops/seminars at
community level, sharing brochures; leaflets; training materials;
training CBR personnel, personal sharing; individual contacts
however unable to cover larger population due to many factors
 To some extent, CBR able to convince, family members, local
health workers, government authority about causes of disability,
process of prevention (to stop secondary form of disability),
impact of assistive devices and rehabilitation services
 Attitude of family members and community changing, a
significant intervention of CBR programme, acceptance of
disability both in family and community (where CBR
1.
Programmes remain active) leading public exposure of persons
2.
with disability
 Although in small numbers CBR Programs help persons with
disability to be empowered socially and economically, making
them realize their own potential, and increasing the acceptance
level of persons with disabilities (where the CBR Programme
remains active and people maintain their involvement with it
 Governments should take sole responsibility of CBR programme with
partnership with other international donors to sustain its effort
because CBR Programme and its support services are needed longterm as new forms of disability are increasing day by day
 Each country should modify international tools according to national
situation, create national plans with active involvement of persons
with disability/DPOs on rehabilitation and establish infrastructure
and capacity to implement the plan as stated; policies and plans
themselves do not work unless actions are taken in due time
 SHGs, providing technical advice/expertise, being more and
1. With
of CBR,the
persons
with disability
forming
their own
moreinitial
vocalhelp
to demand
governments
not only
to increase
allocation of budget but also take ownership and responsibility
of CBR nationally and locally.
Challenges:
 Sustainability of CBR Programmes and support services remains
the major challenge, mostly international donor driven projects
 Ownership of CBR programme missing, leading to closure of
CBR programme after donors phase out
 Apart from allocating a small budget to NGOs working in
disability development, most governments have not taken
responsibility of CBR Programme in developing countries (Nepal
one of them)
 Some countries have legislation and policies related to
rehabilitation but implementation of these policies missing due
to lack of strategic planning, very limited resources, no
involvement of persons with disability, lack of monitoring and
evaluation process, no updated data on disability
 Role of INGOs and their budget allocation in the area of
rehabilitation development is missing, still remains a least
priority area in development sector
 Some DPOs not understanding real concept of CBR Programme,
still considering it as medical model whereas it has gone to
cover every needs of persons with disability for their quality of
life
 Involvement of persons with disability/their DPOs in all stages of
CBR Programme is very much required while planning programmes,
implementing, monitoring and evaluation
 Organizations/groups of persons with disability need to understand
social impact of CBR Programme besides medical benefits because
CBR has evolved into a multisectoral strategy to improve the quality
of life of persons with disability and ensure their empowerment,
participation and inclusion in society
 CBR Programme should actively involve family members, local
authority, women’s groups, dedicated volunteer and their effort
should be acknowledged in special events of CBR Celebration
 CBR Programme should train more and more female personnel as
many girls/women feel comfortable receiving services and sharing
their concerns with female CBR workers than male CBR workers
 Current CBR programmes often have expertise only in single
disability and persons with multiple disabilities are left out.
Therefore, capacity building is needed both for rehabilitation centres
and CBR Programmes of rehabilitation to address the needs of
multiple disabilities.
 Apart from providing assistive devices, making people aware of
causes and prevention of disability, CBR Programme should continue
to focus on rehabilitation services that could be counseling, daily
living skills, creating public exposure/social network, literacy,
vocational training, linking them to employment (livelihood) etc.
 CBR Projects, DPOs are not partners of other organizations. CBR
and DPOs could be members of other groups that exist in their
community. This would also give them opportunities to interact
with and influence other community members to incorporate
disability development into their programme
 Access to further training for CBR workers in disabilities and a rights
based approach to disability inclusive development is required to
expand CBR Programme and sustain it for long time
 Many CBR Programmes are activities oriented; regular monitoring
and evaluation process is missing about outcomes. Emphasis should
be given for monitoring and evaluation as it helps to detect
problems, challenges and support them to plan better for coming up
programmes. Evaluation also helps to see if planned strategies and
activities have the desired impact
 Acceptance of disability from oneself, from family members and
from community is still a key issue in developing countries
depending on various circumstances. Therefore CBR Programme
should expand and improve its programme not only in major cities
but also in most remote areas; also must target any kind of disability
regardless of its severity and gender
 There is urgent need of collecting data on various types of
disabilities and this will help them to improve their services.