CBR-AhmedRefat (2)

8/3/2019 CBR-AhmedRefat (2)

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DR. AHMED-REFAT REFATT I B AH U N IV E R SI T Y, K S A

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Community-Based PhysiotherapyBasic Concepts

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Dr. Ahmed Refat AG Refat


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1- Healthit is a state of complete physical, mental and social

well-being and not merely the presence of disease or

infirmity .

Health is a valuable resource that enables peopleto lead individually, socially and economically

productive lives, providing them with thefreedom to work, learn and engage actively in

family and community life.

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Basic Concepts 1: Health



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Convention on the Rights of Persons with Disabilities,

which states that disability is:

An evolving concept and results from the interaction

between persons with impairments and attitudinal

and environmental barriers that hinders their full and

effective participation in society on an equal basis

with others .

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2-Disability & Rehabilitation- cont.,



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Peoples experiences of disability are extremelyvaried. There are different kinds of

impairments and people are affected in different ways.

Some people have one impairment, others multiple;some are born with an impairment, while others mayacquire an impairment during the course of their life

The Convention on the Rights of Persons with

Disabilities describes people with disabilities asthose who have long-term physical, mental,

intellectual or sensory impairments .

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Disability is no longer viewed as merely the result ofimpairment. The social model of disability has

increased awareness that environmental barriers

to participation are major causes of disability.The International Classification of Functioning,

Disability

and Health (ICF) includes body structure and function,

but also focuses on activities and participationfrom both the individual and the societal perspective.

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Approximately 10% of the worlds populationlives with a disability ..

People with disabilities constitute the worlds

largest minority.An estimated 80% of people with disabilities

live in developing countriesAn estimated 15 20% of the worlds poorest

people are disabledNo rehabilitation services are available to

people with disabilities in 62 countries .

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Disability : Global Statistics

Dr.Ahmed Refat AG Refat


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Only 515% of people with disabilities can

access assistive devices in the developing

world

Children with disabilities are much less likely toattend school than others

People with disabilities tend to experience higher

unemployment and have lower earnings thanpeople without disabilities .

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Disability : Global Statistics



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Community-Based Physiotherapy

Origen of the " Community-basedphysiotherapy / rehabilitation (CBR)"concept

y The declaration ofAlma-Ata in 1978 was the firstinternational declaration advocating primary healthcare as the main strategy for achieving the WorldHealth Organizations (WHO) goal of health for all .

This strategy was intended to enhance the qualityof life for people with disabilities throughcommunity initiatives.

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y Following the Alma-Ata declaration,WHO

introduced CBR. In the beginning CBR wasprimarily a service delivery method making

optimum use of primary health care and

community resources, and was aimed at bringingprimary health care and rehabilitation services

closer to people with disabilities, especially in low-income countries .

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y During the 1990s, along with the growth in number of

CBR programmes, there were changes in the way CBR

was conceptualized. Other UN agencies, such as the

International Labour Organization (ILO), United NationsEducational, Scientific and Cultural Organization

(UNESCO), United Nations Development Programme

(UNDP), and United Nations Childrens Fund

(UNICEF) became involved, recognizing the need fora multisectoral approach.

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y In 2003, an International consultation to review

community-based rehabilitation held in Helsinki made a

number of key recommendations . Subsequently, CBR

was repositioned, in a joint International LabourOrganization (ILO)/United Nations Educational, Scientific

and Cultural Organization (UNESCO)/WHO position

paper, as a strategy within general community

development for the rehabilitation, equalization ofopportunities, poverty reduction and social inclusion

of people with disabilities .

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y CBR is implemented through the combined efforts

of people with disabilities themselves, their families,

organizations and communities, and the relevant

governmental and non-governmental health,education, vocational, social and other services.

y ( ILO, UNICEF, WHO. CBR: joint position paper ; 2004 ).

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(1) Community Based Rehabilitation (CBR): as 'peopletaking care of themselves'

(2) (2) Community Based Rehabilitation: as a Concept andas an IdeologyCBR as a concept and an ideology, promotes a de-centralized approach to rehabilitation service-delivery

(3) (3) Community Based Rehabilitation Programs,

Projects and Organizations (mostly by NGOs)

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There are currently 3 meanings attached to 'CBR':



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y Essential Elements of CBR

y CBR requires community and DPO/PWD Disabled People's

Organisations involvement. But communities and DPOscannot work alone to ensure equal opportunities forpeople with disabilities. National policies, amanagement structure, and the support of differentgovernment ministries, NGOs and other

stakeholders (multi-sectoral collaboration) are alsoneeded.

Elements of CBR



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y Country approaches to implementing CBR vary agreat deal, but they have some elements in common thatcontribute to the sustainability of their CBR programmes.These include:

y I. National level support through policies, co-ordinationand resource allocation.

y II. Recognition of the need for CBR programmes to bebased on a human rights approach.

y III. The willingness of the community to respond to theneeds of their members with disabilities.

y IV. The presence ofmotivated community workers.

Sustainability of CBR Programmes



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Multi-sectoral Support for CBR

y In CBR a multi-sectoral collaboration is essential to

support the community, address the individual needs

of people with disabilities, and strengthen the role ofDPOs.

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Support for CBR



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y 1 Support from the Social Sector

y 2 Support from the Health Sector

y 3 Support from the Educational Sector

y 4 Support from the Employment Sector

y 5 Support from NGOs

y 6 Support from the Media

y

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Support for CBR


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y CBR facilitates access to basic needs, and at thesame time promotes equal opportunities and equal

rights. It is therefore a multisectoral strategy withsome key principles to enable people with disabilities

to participate in the whole range of human activities.

y The principles outlined below are overlapping,

complementary and inter-dependent

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Principles of CBR


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1. Inclusion

2. Participation

3. Empowerment

4. Equity5. Self -advocacy

6. Facilitation

7. Gender sensitivity and special needs

8. Partnerships

9. Sustainability

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Principles of CBR


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y 1- InclusionCBR works to remove all kinds of barriers which blockpeople with disabilities from access to the mainstream ofsociety. Inclusion means placing disability issues and people

with disabilities in the mainstream of activities.

y 2- ParticipationCBR focuses on abilities, not disabilities. It depends onthe participation and support of people with disability, family

members and local communities. It also means theinvolvement of people with disabilities as active contributors tothe CBR programme, from policy-making to implementationand evaluation, for the simple reason that they know whattheir needs are.

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Principles of CBR


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y 3- Empowerment

Local people and specifically people with disabilitiesand their families, ultimately may make the programme

decisions and control the resources. This requires peoplewith disability taking leadership roles withinprogrammes. It means ensuring that CBR workers,service providers and facilitators include people withdisabilities and that all are adequately trained and

supported. Results are seen in restored dignity andself-confidence.

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Principles of CBR


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y 4- Equity

y CBR emphasizes equality of opportunities and rights

equal citizenship.y Raising awareness CBR addresses attitudes and

behaviour within the community, developingunderstanding and support for people withdisabilities and ensuring sustainable benefits. It alsopromotes the need for and benefit of inclusion ofdisability in all developmental initiatives.

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Principles of CBR


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y 5- Self Advocacy.,

y CBR consistently involves people with disabilities in

all issues related to their well-being. Selfadvocacy is

a collective notion, not an individualistic one.It means self-determination. It means mobilizing,organizing, representing, and creating space for

interactions and demands.

y

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Principles of CBR


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y 6- Facilitation

y CBR requires multisectoral collaboration to support

the community and to address the individual needsof people with disability, with the ultimate aim of aninclusive society.

y

7- Gender sensitivity and special needsCBR is responsive to individuals and groups withinthe community with special needs.

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Principles of CBR


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y 8- Partnerships

y CBR depends on effective partnerships with community-basedorganizations, government organizations and other organizedgroups.

y 9- Sustainability

y CBR activities must be sustainable beyond the immediate life of theprogramme itself. They must be able to continue beyond the initial

interventions, and be independent of the initiating agency. Thebenefits of the programme must be long-lasting.

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Principles of CBR


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Common Framework of CBR Programmes

y In light of the evolution of CBR into a broader

multisectoral development strategy, a matrix wasdeveloped in 2004 to provide a common framework

for CBR programme .y The matrix consists offive key components:

the health, education, livelihood, social andempowerment components.

Within each component there are five elements.

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CBR Matrix


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1- Health promotion

y Health promotion aims to increase control over

health and its determinants.

y The wide range of strategies and interventionsavailable are directed at strengthening the skills of

individuals and changing social, economic and

environmental conditions to alleviate their impacts on

health.

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Elements of Health Components -1


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2- Preventiony Prevention is very closely linked with health

promotion. Prevention of health conditions (e.g.

diseases, disorders, injuries) involves primaryprevention (avoidance), secondary prevention (earlydetection and early treatment) and tertiaryprevention (rehabilitation) measures. The focus of

this element is mainly on primary prevention.

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3- Medical care

y Medical care refers to the early identification,assessment and treatment of health conditions and

their resulting impairments, with the aim of curing orlimiting their on individuals. Medical care can take

place at the primary, secondary or tertiary level of

the health-care system.

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4- Rehabilitationy Rehabilitation is a set of measures which enables

people with disabilities to achieve and maintain optimalfunctioning in their environments; it is relevant both forthose who acquire disabilities during their lifetime and forthose who have disabilities from birth.

y Rehabilitation services range from the basic to thespecialized and are provided in many different

locations e.g. hospitals, homes and communityenvironments. Rehabilitation is often initiated by thehealth sector but requires collaboration between allsectors.

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5- Assistive devicesy A device that has been designed, made or adapted to assist a

person to perform a particular task is known as an assistivedevice.Many people with disabilities benefit from the use ofone or more assistive devices. Some common types ofassistive devices are: mobility devices (e.g. walking sticks,wheelchairs), prostheses (e.g. artificial legs), orthoses (e.g.hand splint), visual devices (e.g. glasses, white canes) andhearing devices (hearing aids).

y To ensure that assistive devices are used effectively,important aspects of their provision include user education,repair, replacement and environmental adaptations in thehome and community.

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Desired Outcome

and the Role of CBRin each Elements

of Health Component

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GoalThe health potential of people with disabilities and their families is

recognized and they are empowered to enhance and/or maintainexisting levels of health.

The role of CBRy The role of CBR is to identify health promotion activities at a local,

regional and/or national level and work with stakeholders (e.g.ministries of health, local authorities) to ensure access andinclusion for people with disabilities and their family members.

y

Another role is to ensure that people with disabilities and theirfamilies know the importance of maintaining good health andencourage them to actively participate in health promoting actions.

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1- Health Promotion,


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1- Health Promotion-cont,

Desirable outcomesy People with disabilities and their families are reached by

the same health promotion messages as are members ofthe general community.

y Health promotion materials and programmes aredesigned oradapted to meet the specific needs of peoplewith disabilities and their families.

y People with disabilities and their families have theknowledge, skills and support to assist them to achievegood levels of health.

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1- Health Promotion-cont,

Desirable outcomesy Health-care personnel have improved awareness

about the general and specific health needs of people

with disabilities and respond to these through relevanthealth promotion actions.

y The community provides a supportive environment forpeople with disabilities to participate in activities whichpromote their health.

y CBR programmes value good health and undertakehealth-promoting activities in the workplace for their staff.

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The role of CBRy The role of CBR is to ensure that communities and

relevant development sectors focus on prevention

activities for people both with and without disabilities.CBR programmes provide support for people with

disabilities and their families to ensure they can access

services that promote their health and prevent the

development of general health conditions orsecondary conditions (complications).

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2- Prevention ,


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Desirable outcomesy People with disabilities and their families have access

to health information and services aimed at preventing

health conditions.y People with disabilities and their families reduce their

risk of developing health problems by taking up andmaintaining healthy behaviours and lifestyles.

y

People with disabilities are included and participatein primary prevention activities, e.g. immunizationprogrammes, to reduce their risk of developing additionalhealthconditions or impairments.

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2- Prevention -cont,


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Desirable outcomesy All community members participate in primary

prevention activities, e.g.immunization programmes,to reduce their risk of developing health conditions or

impairments which can lead to disability.

y CBR programmes collaborate with the health and

other sectors, e.g. education, to address healthissues and provide support and assistance for

prevention activities.

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2- Prevention -cont,


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Goaly People with disabilities access medical care, both

general and specialized, based on their individual needs.

The role of CBRy The role of CBR is to work in collaboration with people

with disabilities, their families and medical services to

ensure that people with disabilities can access servicesdesigned to identify, prevent, minimize and/or correct

health conditions and impairments.

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3- Medical Care


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Desirable outcomesy CBR personnel are knowledgeable about medical care

services and able to facilitate referrals for peoplewith disabilities and their families for general or specializedmedical care needs.

y People with disabilities and their families access activities

that are aimed at the early identification of health

conditions and impairments (screening services).y Medical care facilities are inclusive and have improved

access for people with disabilities.

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3- Medical Care -cont,


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Desirable outcomesy People with disabilities can access surgical care to minimize or

correct impairments, thus contributing to improved health andfunctioning.

y People with disabilities and their families develop self-management skills whereby they are able to askquestions, discuss treatment options, make informed decisionsabout medical care and manage their health conditions.

y

Medical care personnel have increased awarenessregarding the medical needs of people with disabilities, respecttheirrights and dignity and provide quality services.

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3- Medical Care -cont,


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Goaly People with disabilities have access to rehabilitation

services which contribute to their overall well-being,

inclusion and participation.

The role of CBRy The role of CBR is to promote, support and

implement rehabilitation activities at the communitylevel and facilitate referrals to access morespecialized rehabilitation services.

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4- Rehabilitation,


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Desirable outcomes

y People with disabilities receive individualassessments and are involved in the development

of rehabilitation plans outlining the services they willreceive.

y People with disabilities and their family membersunderstand the role and purpose of rehabilitation andreceive accurate information about the servicesavailable within the health sector.

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4- Rehabilitation -cont,


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Desirable outcomesy People with disabilities are referred to specialized

rehabilitation services and are provided with follow-up toensure that these services are received and meet their needs.

y Basic rehabilitation services are available at thecommunity level.

y Resource materials to support rehabilitation activitiesundertaken in the community are available for CBR personnel,people with disabilities and families.

y CBR personnel receive appropriate training, educationand support to enable them to undertake rehabilitationactivities.

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4- Rehabilitation -cont,


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Rehabilitation servicesy (e.g. nurses, physiatrists), therapy professionals

(e.g. occupational therapists, physiotherapists,

speech therapists), technology specialists (e.g.orthotists, prosthetists) and rehabilitation workers(e.g. rehabilitation assistants, communityrehabilitation workers).

y Rehabilitation services can be offered in a widerange of settings, including hospitals, clinics,specialist centres or units, community facilities andhomes.

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4- Rehabilitation-cont,


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yGoaly People with disabilities have access to appropriate

assistive devices that are of good quality and enablethem to participate in life at home and work and in thecommunity.

y The role of CBRy The role of CBR is to work with people with disabilities

and their families to determine theirneeds for assistivedevices, facilitate access to assistive devices andensure maintenance, repair and replacement whennecessary.

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5- Assistive Devices


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yDesirable outcomesy CBR personnel are knowledgeable about assistive

devices, including the types available, theirfunctionality and suitability for different disabilities, basicfabrication, availability within communities and referralmechanisms for specialized devices.

y People with disabilities and their families are

knowledgeable about assistive devices andmake informed decisions to access and use them.

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5- Assistive Devices-cont,


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yDesirable outcomesy People with disabilities and their families are provided with

training, education and follow-up to ensure they use and carefor their assistive devices appropriately.

y Local people, including people with disabilities and their families, areable to fabricate basic assistive devices andundertake simple repairs and maintenance.

yBarriers preventing access to assistive devices, such asinadequate information, financial constraints and centralized serviceprovision, are reduced.

y Environmental factors are addressed to enable individuals to use

their assistive devices in all locations where they areneeded.

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5- Assistive Devices-cont,


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Literature Cited

y 1- WHO: Community-based rehabilitation guidelineshttp://www.who.int/disabilities/cbr/guidelines/en/index.html

y 2- World Bank: Community Based Rehabilitation (CBR): http://go.worldbank.org/FC3XJWLK00

y 3- The United Nations Economic and Social Commission forAsia and the Pacific (ESCAP)

Understanding Community-Based Rehabilitationhttp://www.unescap.org/esid/psis/disability/decade/publications/cbr.asp

y 4- CBR:A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of Peoplewith Disabilities (Joint Position Paper2004)

http://whqlibdoc.who.int/publications/2004/9241592389_eng.pdf

y 5. Declaration of Alma-Ata: International conference on primary health care, Alma-Ata, USSR, 612September1978, Geneva, World Health Organization, 1978 (www.who.int/hpr/NPH/docs/declaration_almaata.pdf, accessed 10August 2010).

y 6. International Labour Organization, United Nations Educational, Scientific and Cultural Organization,World Health Organization. CBR: A strategy for rehabilitation, equalization of opportunities, povertyreduction and social inclusion of people with disabilities. Joint Position Paper 2004. Geneva, World Health Organization,

2004(www.who.int/disabilities/publications/cbr/en/index.html, accessed 10August 2010).

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Dr. Ahmed Refat AG Refat www.SlideShare.net/AhmedRefat


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Example CMR- P


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Example CMR- P


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y The main objectives of the program are:1- Change the community perceptions toward disability andcreate a new and positive community outlook (changing attitudes).

y 2- Transferknowledge to the community through communityeducation and other activities.

y 3- Improve the quality of life of the disabled people by maximizingtheir independence and self reliance.4- Promote the policy ofearly detection and early intervention.5- Promote school mainstreaming for disabled children in thearea.6- Mobilize the local community through their engagement and

y

7- participation in the programe activities.8- Strengthen the capacity of the program through continuingeducation for the team (formal and informal training).


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y General objectives:

The main goal is to reach the largest possible

number of disabled people in their directenvironment to meet theirneeds with reliance ocommunity resources ad community involvement,seeking to promote social welfare and achieve full

social integration of persons with disability withintheir communities.


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y Objectives:1. Achieve social integration for disabled personsin all life aspects.2. Ensure equal opportunities, social justice and

protect human rights.3. Improve the quality of life of the disabled peopleby maximizing their independence and self reliance.4. Change the community perceptions and attitudes

toward persons with disability and their rights.5. Promote the policy of early detection and earlyintervention and link CBR with PHC activities.


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y Programs services:

1. Home visits to disabled persons and training of family members toimprove their skills and abilities to participate in the family and social life.

2. Preventive activities: tests and education aimed at early detection ofdisabilities.

3. Community activities: including community education on the rights of disabledpersons and their social integration.

4. Capacity building: Including ongoing education for the staff and regulartraining sessions for volunteers from the local communities on CBR, voluntary work,rights, gender, democracy, psychosocial support, and self organization of disabledpersons.

5. Coordination and networking with local institutions on

rehabilitation and disability issues.6. Psychosocial support to disabled persons and their families.

7. Community surveys in all the villages of the area on disability, as wellas other studies and research related to the Program.


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y http://www.disabilityworld.org/01-

02_01/news/cbreditorial.htm


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Thank You

Ahmed-Refat

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CBR-AhmedRefat (2)