Interview with WHO's Focal Point for CBR
Mr. Chapal Khasnabis

"They should not be treated differently because of their disability"

Mr. Chapal Khasnabis, technical officer of the World Health Organization's (WHO) disability and rehabilitation team was a guest lecturer for APCD's Refresher Training to Strengthen the Community-based Rehabilitation (CBR) through a Participatory Comprehensive Approach 2007 and shared the United Nations and World Health Organization's perspective on CBR.

1. From your perspective, please give us a brief definition of CBR.

   Mr. Chapal: I would say that there is no one concrete definition of CBR. The way CBR is introduced today will be different tomorrow. There will be many changes but we believe CBR is a community action or community initiative to ensure people with disabilities and their families have equal access to opportunity and rights like other citizens in the community. For example, they should have the same equal access to health care, education, livelihood opportunity, social life and political participation or whatever anybody else does in the society, disabled person should do the same. That is what we believe in CBR

2. What do you think about the concept of Medical model and Social model in CBR?

   Mr. Chapal: I think there are a lot of misconceptions and misunderstandings in these whole issues. And it's very difficult to give you an answer in short time to make these whole issues clear because there are a lot of deep thinking is required why it has happened and how to come out of it. But if you see the word rehabilitation in the oxford dictionary, it doesn't connect with the medical model. Rehabilitation could be for anybody. Rehabilitation is a very common term which pushes you back into the mainstream. But some medical experts have medicalised it and gave a varied medical definition of rehabilitation. So rehabilitation is not a medical word but it is a generic word even I need rehabilitation time to time. So we are trying to take it back to generic term rather than medical term. Now CBR came as a strategy if you see the original definition of CBR, it never says anything about medical. It says that optimum utilisation of community resources. It never says optimum utilisation of medical resources. For example, it took us 25 years in many countries' constitution on national plan to introduce the word CBR as a strategy for reaching out. And if we'd like to bring another word, we will take another 25 years? So is the word important or is the action important? That's what people have to make a decision. And when you see this new guideline come out, we define CBR as a community-based inclusive development. So actually CBR is a strategy for community-based inclusive development. Therefore, there is no social model or medical model as well as no any model in this world can be for everybody. People needs are different. You cannot have the same approach or same model for everything. So you should have some common approaches and those common approaches are community initiative, inclusion, poverty reduction, and meeting basic needs. And then you can go further details according to groups' need or individuals' need. I'm more interested how I can make impact in peoples' life. How I can ensure that disabled persons who live in a rural area can come out of poverty. They should not be treated differently because of his/her disability.

3. WHO is the one who initiated the CBR more than 20 years ago. At the moment, what is the WHO's role to support the CBR?

   Mr. Chapal: When WHO introduced CBR, that time, disability scenario on the need and people's understanding had a lot of differences. That time we didn't have the international year of disabled persons, UN standard rules or UN convention, so that time I can say it was a small beginning. WHO realized that each existing specialisation we have, rehabilitation centre or institute based-care, were not good for disabled people. So WHO, in 1978, introduced the concept called Health for All, to go away from the city to the rural areas and the primary health care program. There was also Alma-Ata declaration saying about health for all. And following that many realised if we only depend on the city based institute, we are not able to reach too many people. So we went to the community and then CBR came as a natural consequence of that approach, that is, go to the community from the city or go to the community initiative rather than institute based programme or the institutional care. But now disability movement is quite strong. That time it was quite weak. So CBR also has to change. Therefore, WHO is trying to work in partnership with other UN organisations and disabled peoples' organisations to see a common ground that how we can ensure the UN convention can go to the community, for example. And WHO is in partnership with ILO, UNESCO, and International Disability Alliance (IDA), IDA members including DPI. We are developing CBR Guidelines which we will publish in 2008. We hope that Guidelines will be able to give more impetus to ensure CBR become holistic and moralised base. So we try to see CBR as a strategy for poverty reduction as well as inclusion.

4. What is your expectation to utilise the CBR guidelines and how will you implement it?

   Mr. Chapal: Since 20 years ago, when CBR manual was developed. It was one of the most successful documents. Even in WHO, it was translated to more than 50 languages. So we expect this guideline will also make a similar impact and maybe a larger impact because that guideline was produced only by WHO. But this guideline has been jointly produced by ILO, UNESCO, IDA, and many INGOs. All big agencies supporting CBR on disability rehabilitation are involved in this development. So it is a larger ownership. You will also see that the basic minimum need is a health and education livelihood. That is why we brought ILO, UNESCO, WHO together. So it is a bigger group working together for the first time in a document and we also try to develop a resource group who will support the implementation of the guidelines into the countries, for example, developing a global CBR resource centre with 3 continental resource centres in Asia, Africa and South America. Due to the problem on different languages, we try to develop full of resource persons with different linguistic background or cultural background. We are also developing a global database of CBR programme and resource persons at the same time. So when the guideline is launched, there will be a back up group to do that.

5. What do you see the future of CBR in the Asia-Pacific region.

   Mr. Chapal: Future of anything depends on the need, the people, and the leadership. So as far as our understanding goes, needs do increase everyday, and the population growth, this CBR guidelines has more comprehensive approach rather than a kind of one track approach. And there are strong group in this region, UNESCAP, JICA or APCD, which all are quite interested in promoting CBR. So I see a very good future.