HEALTH CARE STRATEGIES

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 LECTURE OVERVIEW

1. General approaches in CBR

2. Strategies used in CBR practice

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GENERAL APPROACHES
1. Learning from the people

2. Building and upgrading the system from below

3. Do not look for instant or easy solutions

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 LEARNING FROM THE PEOPLE
 We should learn management from local community leaders, and
principles of community work from existing co-operatives and
development committees, and we should learn to respect the abilities
and experience of the local people - and listen carefully to their views.

Hence, the principle is to look for what there is already and to learn
from the people - this should be the point of departure of any development
effort.

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 BUILDING AND UPGRADING THE
SYSTEM FROM BELOW (BOTTOM UP)
 The CBR system endeavours to start development from below, by first
encouraging the establishment of community services and, at a later
stage, linking them to a referral system.

The referral system should be created once the community needs are
known, preferably after a certain period of implementation.

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 DO NOT LOOK FOR INSTANT OR
EASY SOLUTIONS
 There are no quick or easy solutions

 It will take years to adapt the technology to suit individual

requirements, to inspire community involvement and organisation to train
all the necessary personnel, to set up service systems to cover entire
populations, to build up management resources, and to locate the
necessary funds

There is no such thing as a standardised CBR system, nor can this

system be copied from country to country

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 HEALTH CARE STRATEGIES

INSTITUTION OUTREACH COMMUNITY

BASED REHABILITATION BASED
REHABILITATION SERVICES REHABILITATION
SERVICES

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INSTITUTION BASED REHABILITATION
SERVICES
1. Hospital/ Residential care

2. More focus on the patients disability rather than the community,

family or social matters

3. Expensive services

4. Located in urban areas, therefore, inaccessible to the people living

in the interiors

5. Plays an integral part in the referral system as it consists of high

technology services & equipments necessary for diagnosis or
surgical interventions
(I2CPE)

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 OUTREACH REHABILITATION
SERVICES

1. Visit by a health care personnel to the homes of the disabled

2. Focuses on the disabled person & also the family

3. Education & vocational training generally not included

4. Community involvement is limited

5. Cost of treatment is high

6. Valid part in the referral system, when it is aimed to reach the remote
areas (TC2PVD)

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 COMMUNITY BASED REHABILITATION
1. Active role of PWD, their families & the community in the rehab process

2. Basic training skills are transferred to the PWD & their families along
with community members

3. Removes attitudinal barriers in facilitates equal & active participation of

PWD in all aspects of life

4. A person is available to work with the PWD & their families in the
community

5. Community resources are supported by referral services

6. Skilled personnel in rehabilitation trains the community workers to

transfer the knowledge & skills when needed (A2B2ST)

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 SELECTING A STRATEGY
1. Appropriate for achieving the program objectives & implementing
activities

2. Appropriate for achieving increased coverage

3. Compatible with present policies & structures

4. Applicable by available services & personnel

5. Affordable

6. Sustainable
(A4CS)

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STRATEGIES IN INDIA
1. Volunteers as local supervisors

2. Educational model

3. Awareness creation

4. Utilizing local resources

5. Need-based approach

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VOLUNTEERS AS LOCAL
SUPERVISORS

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 EDUCATIONAL MODEL
 Rather than a purely medical or social model, the project attempted a
judicious mixture of both, through an “educational model”.

 This envisages the creation of trained resource people (LS) in the

community who can then utilize the skills and knowledge acquired to
help persons with disabilities.

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 AWARENESS CREATION
 Community awareness was focused on prevention of impairments,
eliminating social stigma and how to include persons with disabilities in the
community.

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 UTILIZING LOCAL RESOURCES
 The primary emphasis was on using locally available resources wherever
possible,
e.g. innovative devices, mobility aids, support from local people.

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 NEED-BASED APPROACH
 If the community and persons with disabilities are to be empowered, it is
crucial to ascertain the needs as perceived or felt by them.

A need-based approach was therefore adopted in planning, with the

understanding.

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ACTIVITIES
1. Defining the community or area of operations

2. Entering the community

3. Selection of volunteers

4. Training

5. School education

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DEFINING THE COMMUNITY
OR AREA OF OPERATIONS

 The community and the target group for CBR should be clearly
defined at the outset of any programme.

This could be decided based on proximity to available

resources, requests from the community, availability of
infrastructure and possibility of linking with existing services,
either government or NGO.

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ENTERING THE COMMUNITY

 To initiate the CBR process, the community must become

aware not only of the needs and problems of persons with
disabilities, but also be confident that there are solutions possible
within the community.

 This awareness may arise within the community through one or

a group of its members.

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 SELECTION OF VOLUNTEERS
 they should be from the local community

 they should be able to read and write the local language;

 they should have family support;

 they should have time to spare for community activities (2–3 hours a
day)

 they should have a positive attitude towards persons with disabilities

and community development

 they should have experience in dealing with disability or could be

persons with disabilities themselves.

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TRAINING

 The aim of training was to create awareness, enhance

knowledge and provide skills needed so that volunteers and
persons with disabilities could be effective agents of change in
the community.

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SCHOOL EDUCATION
 Schools in the community served as a platform to sensitize
children on disability issues.

 This increased the awareness on disability through dramas

role-plays, competitions and skits, necessitated involvement of
teachers and parents and thus percolated down to the larger
community.

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SUMMARY

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THANK YOU

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