COMMUNITY BASED REHABILITATION

A critical review of community based rehabilitation programmes for the disabled



A critical review of community based rehabilitation programmes for the disabled

Introduction

This article challenges the notion that we have much to learn from developing countries as well as much to offer to them. The article describes the philosophy, model and services of Community-Based Rehabilitation (CBR) as one example of what developing countries have to offer us. We discuss parallels between the CBR model and strategies used in the U.S. to meet rehabilitation needs and illuminate CBR practices from which we can learn.

Service providers in the less developed countries often turn to the developed countries to ask, "How do you educate your children with special needs in the U.S.? Should we open special schools? Should we integrate these children? What can we learn from your past mistakes? "

The World Health Organization (Mendis & Nelson, 1983) estimates that about 10% of the world's population has some sort of disability and that 75% of people with disabilities live in developing countries. We often assume that our models must be exported and replicated to insure that adequate services are available to children and youth with special needs, but rarely assume that we can learn a great deal from the "developing" countries. As described by Helander (1993) rehabilitation programs for children and youth with disabilities are typically based on three assumptions: (a) services must be provided through formal organizational structures; (b) services must be provided by formally trained and experienced professionals; and (c) programs need to be multifaceted, comprehensive, and include a variety of specialists, materials, equipment and strategies in order to meet the complex habilitation and rehabilitation needs of persons with impairments.

Those of us who have worked in developing countries know that these assumptions are not always valid. One model from which the U.S. can learn is Community-Based Rehabilitation (CBR) used widely in Asia, Africa and Latin America.

Rationale and History of Community-Based Rehabilitation

In the CBR model, local community members are trained to provide services to those with disabilities. The model is community and home-based, not institution-based. It was developed in response to pressing needs that are prevalent in developing countries, including a lack of trained staff; lack of funds for buildings and materials; limited numbers of university or other formal training programs; limited access to institutionalized services, most of which are situated in urban areas; significant under-utilization of existing services; and a high prevalence of people with disabilities (O'Toole, 1991).

Typical formal models of rehabilitation receive severe criticism in developing countries. "The undue concentration on an urban elite, adoption of unnecessarily high standards of training, the narrowness of specializations and the isolation from normal life, are some of the criticisms levelled at the institutional- based approach" (O'Toole, 1991, p. 9). The CBR model attempts to meet the individual community needs by enabling the community itself to design and implement services.

O'Toole (1991) and others assert that limitations of formal institutional-based models are also apparent in the ...