Community Based Rehabilitation Approaches
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The document discusses different approaches to rehabilitation, including institutional based rehabilitation (IBR) and community based rehabilitation (CBR). IBR focuses on medical issues and takes place in cities/institutions, while CBR is community based, involves persons with disabilities in decision making, and provides holistic services. CBR is more proactive, identifies issues early, and provides guaranteed follow up care at people's doorsteps at a lower cost than IBR. The document also notes some limitations and advantages of CBR programs.
Community Based Rehabilitation Approaches
- 1. AVANIANBAN CHAKKARAPANI Lecture 5 Date:21.1.15 Time: 11.00 am to 12.00pm Venue: K 401 INTRODUCTION TO CBR
- 4. Followed by Institutes i.e. Institutional Based Rehabilitation (IBR). Usually from Centre/ Outreach/ Mobile/Camp. Service providers only concentrate on medical problems . Prescribe, occasionally intervenes and consider medical rehabilitation is the only answer- RELATIONSHIP OFTEN GIVER & TAKER. MEDICAL MODEL
- 5. 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 Medical + Social Model :
- 7. IBR CBR Location Cities and Institution Based Anywhere and community based Decision Makers Service Providers(one way traffic) PWD and their family Service providers Many Professionals CBR workers or semi professionals Action Usually responsive proactive Identification Delayed Early Intervention Delayed Early Follow Up ???? Guaranteed Services Far. Lose Daily Wages At door step Complicated problems Easy to tackle Difficult Cost of care Expensive Cheap Services Medical Holistic Different Approaches to Rehabilitation
- 8. Home based Less expensive Existing community responses and resources Focus on quality rather than quantity Multiple approaches based on community needs Advantage of CBR Programmes
- 9. 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) Limitations of CBR Programmes
- 10. › 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 What CBR is about?
- 11. 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 Good CBR Programme
- 12. A good CBR PROGRAMME, SMALL existing community input (knowledge and skills) should lead to LARGE output (application and energy) Summary
- 13. 1.Mishra S. Occupational Therapy in Community Based Rehabilitation. The Indian Journal of Occupational Therapy; 35(1):2003 2.WHO Expert Committee on Leprosy. WHO (1960) Tech Report Series, No. 189 3.Shah Ebrahim. Health of Elderly People :In Oxford Text-Book of Public Health. Roger Detels, James McEwen, Robert Beaglehole, Heizo Tanaka (Eds).Fourth Edition. Oxford University Press Inc., 2004, New York 4.Werner, David (1997). Nothing about Us without Us: Developing Innovative Technologies For, By and With People with Disabilities. Health Wrights, Palo Alto, California. 5.Guide for Local Supervisors. In Manual, Training in the Community for People with Disability. World Health Organization Geneva 1999. References: