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Community-Based Rehabilitation Training
Report

A Community-based rehabilitation (CBR) approach, according to  the United Nations Educational, Scientific and Cultural Organization (UNESCO), and the World Health Organization (WHO) in 1994, is "a strategy within community development for the community and rehabilitation, equalization of opportunities and social integration of all people with disabilities. CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, educational, vocational, and social services."

APCD's "Workshop for Strengthening Community-Based Rehabilitation Movement"

From 3-12 June 2003, the 1^st community-based rehabilitation (CBR) training course organized by APCD was held in Chiang Mai .The course entitled, "Workshop for Strengthening CBR Movement" adopted a participatory training approach with a focus on "experience sharing" as well as CBR knowledge that is both practical and applicable for the participants.

South to-South Collaboration

Twenty-one persons representing disability-concerned government agencies, NGOs for/of people with disabilities from Cambodia, Laos, Myanmar, Viet Nam and Thailand participated in the training course. Since APCD facilitates South-to-South cooperation, most resource persons for the training course were persons who have been engaged in CBR practices in developing countries such as India, Bangladesh, Sri Lanka, Thailand and Japan

Chiang Mai and Community Development

The training course was conducted in Chiang Mai since the rural area of northern Thailand is comparable to the environments in which the participants will or have initiated CBR in their respective countries. In addition, Community -based support programs were begin carried out there for socially vulnerable persons such as ethnic minority groups and persons with HIV/AIDS in close collaboration between the local Thai government and NGOs. For these reasons, Chiang Mai seemed most appropriate for the participants to experience community-based development.

CBR and Empowerment

For the past two decades, CBR has been highly evaluated and promoted in developing countries all over the world, since it is a strategy for enhancing the quality of life of people with disabilities by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights. Further efforts, however, are necessary to empower people with disabilities, to be facilitators for CBR, to plan, implement and evaluate CBR programs in their own communities. Participants learned the significance of full-participation of people with disabilities in the entire CBR process and the strategies to achieve it. All participants successfully completed the course curriculum with their curriculum with realistic CBR action plans to be developed in their respective countries.

Words from APCD Resource Persons

Mr. A Prasad and Ms. Padmani Mendis are two APCD resource persons for this CBR regional workshop from 3-12 June 2003, shared their feedback. Mr. A Prasad was very positive  stated that it helped with the cross- fertilization experience to influence participants  policy makers to adopt CBR into their policies. CBR, in his perspective is "Empowering PWDs through rights-based approaches for disability rehabilitation and independent living"

Dr. Padmani Mendis stated she expects participants to strengthen or develop new CBR programs with a wider versions from their knowledge and experiences from the workshop to meet objectives of the "Biwako Millennium Framework (BMF)" and to benefit PWDs in their community.

According to Dr. Mendis, CBR is sharing with people who have disabilities, all the opportunities that we have as citizens of our countries. CBR is empowering them so that they can lead a full and satisfying life and providing them with opportunities to fulfill themselves as human beings. CBR is enabling them to contribute to the national development using their knowledge, experiences, skills, and capabilities by including them on the basis of equity in all social development processes.

Comment Regarding CBR Workshop
By Ms. Yukiko Nakanishi,
JICA Short Term Expert

CBR has widely spread throughout Asia and the Pacific since the concept was introduced by the World Health Organization about 20 years ago. Participants in the workshop understood that CBR is a community development approach for persons with disabilities. But when it came to the point of empowering persons with disabilities, however, it became apparent that the majority were not aware of the provisions and measures needed for equal participation. CBR was still viewed as an approach to provide rehabilitation training to community members for persons with disabilities in their homes. Persons with disabilities cannot be empowered through this CBR approach.

This is true to many CBR organizers in the region. That is the reason why the Asia-Pacific Development Center on Disability plans to include CBR training as one of its training courses.

In the second half of the workshop, there was an emphasis to include the components of disabled peoples' organization, inclusive education and independent living in a CBR program, Participants actively discussed how to promote the above components under the leadership of Mr. Somchai who provided Thai/English interpretation and appropriate advice. The plans of action of the participants representing ministries and government organizations showed, they had barriers implementation of the components, whereas it was easier for persons with disabilities to incorporate them into their organization's activities.

CBR has not developed the way the initiators expected, including Dr. Padmani Mendis, one of the resource persons for the workshop. Some disabled persons' organizations in developing countries have started say, "We do not want CBR" By strengthening self-help activities, persons with disabilities gain confidence to develop community-based activities by themselves. Frequently, the activities promote public awareness or generate income and prioritize the independent living concept, especially self-determination and self-management. When persons with disabilities become more aware of their rights in the community, CBR will take a different format, it will form a part of the independent living movement in developing countries. Independent living in developed countries attaches importance to such services as personal assistants and independent living skill training.

On the other, in developing countries it will be advocacy-centered. In fact, the number of campaigns and demonstrations has increased in developing countries which is a sign that the independent living movement is developing.

All resource persons for the CBR workshop agreed to put an emphasis on the participation of persons with disabilities in the CBR workshop next year. CBR is have no services. Until persons with disabilities in the region who have no services, Until persons with disabilities become empowered, APCD is expected to have CBR organizers and implementers take a rights-based approach.

Two Decades of CBR in Asia and the Pacific
By Dr. Padmani Mendis
Consultant in Disability and Rehabilitation, Sri Lanka

Five countries of the Asia-Pacific region participated in the first field trials of CBR with the leadership of WHO from 1979 until 1982, they were India, Indonesia, Myanmar, the Philippines and Sri Lanka.It may be true to say that today over 90% of countries in the region have started CBR programmes. What difference has CBR made to people who have disabilities? Has it influenced their daily living and their future? Has it helped to empower them?

Looking back two decades and to the end of the first global field trial (in which countries from Africa, South America and the Caribbean also participated), a meeting was held in Sri Lanka to evaluate the results, participants included State and NGO national field trial coordinators. Suffice it to say, there were no individuals with disabilities participating in that meeting. The outcome of this finding on the part of WHO was twofold. Firstly, WHO itself established stronger relationships with disability Organizations at global and national levels in order to stimulate their interest in CBR. Secondly, at the micro level, Space was created for people who have disabilities to take their place in local CBR leadership structures, It was at this time that a special component was included in the WHO Manual "Training in the Community for People who have Disability "¹"( ^"1"Helander et al. trainin in the community for People who have Disability WHO Geneve, 1983 ) To promote, together with CBR growth, the formation of grass roots disability organizations.

As a result, today WHO will not convene any forum to discuss CBR and disability without the participation of people who have disabilities. It is a foregone conclusion  That they must be part of any decision-making. However in the Asia-Pacific, the representative leadership that participates in decision-making at the regional level remains confined to a few individuals.

On the other hand, it is at the micro level that the impact of CBR reflects much greater democratization and can best be seen. In areas where CBR has started, individuals who have disabilities are now, as a rule, part of the leadership that takes responsibility for CBR development in their own communities. Individuals and their families increasingly have access to the information, knowledge and skills that they require to access their rights and to overcome the consequences of their disabilities. Disability itself is being detected sooner and children have their right to development protected through early and extra stimulation programmes. They have increasing access to inclusive education Self-employment for adults who have need for Income generation helps to draw them into mainstream community development processes. Advocacy groups have grown from the grass roots. CBR is no longer seen as a "medical" approach. Instead, it is now seen in the way that it was originally conceptualized, namely as a rights-based social development approach.

CBR is reaching individuals who would otherwise not have been reached. This however is no cause for satisfaction. CBR is not growing fast enough. Speeding up its expansion calls for greater involvement of people who have disabilities in its management, particularly in planning and monitoring at the macro level. This is not happening adequately largely due to the fact that they have not as yet known enough about CBR and have therefore not yet realized the potential that CBR offers them for empowerment.

Comminity-Based Rehabilitation Movement of CBR in South East Asia through "Workshop for Strengthening Community-Based Rehabilitation Movement"
By Mr. Somchai Rungsilp
Disability and Development Manager, Handicap International Thailand

This workshop was jointly organized by APCD from 3-12 June 2003 in Chiang Mai, Thailand. The concepts and principles of this workshop were a participatory approach, to share experiences and learn how to have a practical and applicable approach.

The contents of the workshop consisted of the following concepts :

1. Participatory Community Development
2. Participatory Project Management
3. Introduction of the UNESCAP Biwako Millennium Framework.
4. Independent Living
5. Sharing of CBR practices in Thailand, Sri Lanka, Bangladesh and India
6. A field Visit
7. Action Plan Proposals by the participants

All of the participants, resource persons, APCD staff learned much by sharing ideas and experiences. We are confident that this workshop will be another step towards further developing the CBR Movement in Southeast Asia.