Community Based Rehabilitation (CBR)

Community Based Rehabilitation (CBR) was first initiated by the World Health Organization (WHO) in 1978 as a strategy to address access to rehabilitation services for persons with disabilities in developing countries. It focused on decentralised service provision and the use of local resources. Over time, CBR has evolved considerably, reflecting greater recognition of the human rights and needs beyond rehabilitation of persons with disabilities, and the link between disability and poverty.

CBR now represents a multi-sectoral and multi-level strategy within community development for rehabilitation, equalisation of opportunities, poverty reduction and social inclusion of persons with disabilities. It aims to ensure that persons with disabilities and their families are able to access the benefits of mainstream health, education, livelihood and social sector programs. CBR also promotes the inclusion, participation and empowerment of persons with disabilities (and their families) in all development and decision-making processes. Current CBR guidelines and resources are strongly influenced by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

Many CBR resources are developed for grassroots practitioners and increasingly reflect efforts to support programs in moving towards more social and rights based approaches. Donors and government decision makers should be aware of the overall CBR approach and their role in the multi-sectoral and multi-level implementation. This is essential to identifying potential actors and stakeholders who may be supported in their efforts, and to assess the potential for CBR to contribute to providing sustainable solutions in resource constrained settings.

Resources below include international guidelines and frameworks, case studies highlighting good practice, and other resources which adopt a rights based approach and emphasise the need for the inclusion, empowerment and active involvement of persons with disabilities in service delivery.

See also: Assistive devices, Introduction to disability and development, Health, Education, Livelihoods, Participation of persons with disabilities

WHO and Swedish Organizations of Disabled Persons International Aid Association (2002) Community-Based Rehabilitation as we have experienced it... voices of persons with disabilities: Part 1 (PDF 240 KB)

Together with Part 2, these documents report studies conducted in Ghana, Guyana and Nepal on the impact of CBR on quality of life of persons with disabilities. They identify the CBR initiatives perceived as being the most useful. This study provides an illustration in promoting CBR as a strategy for empowering persons with disabilities and community-based development for CBR program managers, development organisations and for organisations involved in evaluating CBR programs.

WHO and Swedish Organizations of Disabled Persons International Aid Association (2002) Community-Based Rehabilitation as we have experienced it... voices of persons with disabilities: Part 2 (PDF 209 KB)

Part 2 of the study provides country profiles from Ghana, Guyana and Nepal.

Humanity & Inclusion Source: Key list resources on community based rehabilitation (updated regularly)

This key list includes introductory resources on CBR, implementation manuals, as well as evaluations and case studies of CBR implementation in many different contexts.

World Health Organization (2010) CBR and Millennium Development Goals (PDF 563 KB)

With the growing recognition that Millennium Development Goals (MDGs) are not achievable without involving persons with disabilities, this short document examines how CBR can be a strategy to contribute to the achievement of MDGs. It suggests activities that can be undertaken in CBR programs to support the 8 objectives of MDGs.

World Health Organization (2010) Community-based rehabilitation guidelines (downloadable in sections; audio files also available)

The CBR Guidelines have been developed in a participatory approach by UN Agencies (WHO, the International Labour Organization, the United Nations Educational, Scientific and Cultural Organization), non-government organisations (such as CBM and Handicap International) and disabled people’s organisations (DPOs). The guidelines focus on key domains of universal well-being: health, education, livelihood, social life and empowerment, which are represented in a matrix. They provide guidance in planning and implementation of CBR programs, and promote CBR as an inclusive development strategy to improve quality of life and empower people with disability and their families. These guidelines are not prescriptive but provide strategies and examples to promote and illustrate a practical approach for CBR. This resource has been designed for implementing partners, particularly program managers/officers within international development agencies. It is also useful for organisations involved in program review and interactions with implementing partners.

World Health Organization (2012) Community-based rehabilitation: Promoting ear and hearing care through CBR (PDF 2 MB)

This document introduces key concepts of hearing loss such as causes and its impact on life and management of hearing loss. In addition it provides activities that can be undertaken under each component of the CBR matrix for implementing ear and hearing care within CBR programs. This document is useful for training CBR workers, DPOs and NGOs working in CBR programs. It is also useful for organisations involved in program review and interactions with implementing partners.

ILO/UNESCO/WHO (2004) CBR: A strategy for rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities (Joint Position Paper 2004) (PDF 1.17 MB)

This paper is a revision of the agencies’ 1994 joint position paper. It promotes CBR as a strategy for community development and encourages participation of persons with disabilities in planning and implementation of CBR programs. It promotes multi-sectoral collaboration for CBR to reach different community groups. Following this joint position paper, new CBR guidelines were developed to support planning and implementation of CBR programs. This document is useful for development agencies to understand the link between CBR and community development, and the context in which the CBR guidelines emerged.

Disability, CBR & Inclusive Development (DCID)

Formerly known as Asia Pacific Disability and Rehabilitation Journal, this is an open access peer-reviewed journal on CBR around the world. Four volumes a year are published. Its focus is evidence-based information to address needs of practitioners (particularly those from developing countries), policy makers, organisations of persons with disabilities and the scientific community.

World Health Organization and International Federation of Anti-Leprosy Associations (ILEP) (2007) Technical guide on community-based rehabilitation and leprosy (PDF 666 KB)

This manual provides guidance for leprosy management in CBR programs in line with the CBR matrix. This is a technical guide, providing activities/tasks for program managers and CBR workers to undertake several activities related to involving communities, advocacy, interventions for leprosy, forming self-help groups and empowering people with disability and their families. The manual was intended to be used by managers, trainers and supervisors in leprosy control or rehabilitation programs to implement CBR programs. While the manual is focused on leprosy, the recommended activities can also be used for other impairments. It is also useful for organisations involved in program review and interactions with implementing partners.

There are no case studies available

Washington Group on Disability Statistics technical presentation

Jennifer H. Madans Ph.D., Associate Director for Science, National Center for Health Statistics (NCHS) and Mitchell Loeb,
Health Scientist, NCHS from the secretariat of the Washington Group on Disability Statistics delivered a technical session
on how to use the Washington Group questions in monitoring data systems and how to disaggregate data by disability
followed by a question and answer session at the University of Melbourne on Thursday, 30 April 2015. The presentation
was organised by the Australian Government Department of Foreign Affairs and Trade.

Presentation from the Washington Group on Disability Statistics
Picture of a girl from Tanzania who is sitting in a wheelchair fitted with a tray table outside a building.  She is smiling at the female CBR worker who is squatting beside her to her right. Her mother is squatting down in front of her adjusting a strap holding the child’s right foot in place on the wheelchair foot support.

Photo: Tobias Pflanz, 2010

Mary* (middle, aged 10) lives on the slopes of Mount Kilimanjaro in Tanzania. Janeth (right) is a CBR worker who visits Mary twice a month to see her development and give advice to her mother. Mary is really pleased with her new wheelchair which was provided through the CBR program and now has greater mobility. Today she can attend a pre-school, is learning figures and writing. Community Based Rehabilitation is a holistic approach that addresses health, education, livelihoods, social inclusion and empowerment of persons with disabilities. (*Pseudonym used) Copyright: CBM