World Blind Union Office

1929 Bayview Avenue

Toronto, ON M4G 3E8

Telephone: 1-416-486-9698
Fax: 1-416-486-8107
E-mail: [email protected]
www.worldblindunion.org

WBU External Position Statement

Community-Based Rehabilitation

Author: WBU Rehabiliation Working Group

Replaces: September 2003
Date Reviewed: 2014
Approval: May 2014 – WBU Executive

Note: Earlier policy papers approved in 2003 reviewed and updated in

light of UN-CRPD as well as updated CBR guidelines released by World
Health Organization.

1. Purpose

The purpose of this position statement is to promote a common

understanding among our members and encourage them to implement
CBR programmes which are in absolute compliance with the standards
and principles of UNCRPD for the empowerment and development of
persons with visual disabilities with quality services.

While the formal concept of CBR or community based rehabilitation

was developed as a model for the provision of rehabilitation services in
developing countries, many of the concepts that it encompasses are
similarly relevant in developed countries as well. The advent of the
CBR model was intended to ensure standardized and quality
rehabilitation at the community level. This paper examines the formal
concept of CBR from the perspective of WBU but also discusses
rehabilitation in general which may be actualized through different
service models with some being community based and others center
based, but with the underlying non-negotiable principles of inclusion,

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quality and equality.

2. Reasons and statement of objects

2.1 The adoption of the UN Convention on the Rights of Persons with

Disabilities in 2006 (hereinafter referred to as UN-CRPD) brought
a paradigm shift in the field of disability and rehabilitation with
the concept of the social model of disability;
2.2 Launch of the WHO CBR guidelines in 2010 which have adopted
the standards and principles of UN-CRPD in the CBR matrix;
2.3 The WBU resource paper on CBR analysis and principles of
rehabilitation that were adopted 10 years ago might have lost
their relevance due to new developments in the sector;
2.4 Compulsion of service providers in developing countries to reach
a large number of persons with visual disabilities through CBR
strategies without appropriate standards;
2.5 To promote a common understanding among our members on
CBR in order to ensure adequate standards and quality in the
rehabilitation process.

3. Background

Community Based Rehabilitation (CBR) was initiated in the early

1980s, due to the failure of the conventional system of rehabilitation
then prevalent in many developing countries, and the need for an
alternative approach (Helander, 1993). The focus was on coverage of
rehabilitation services for persons with disabilities living in rural areas
in developing countries, at an affordable cost. The main strategy was
transfer of skills to local people, including families (WHO, 1989).
CBR heavily borrows from the health for all campaign and attempts to
extend habilitation and rehabilitation services to a large number of
persons with disabilities.

From the mid-nineties onwards there were major changes in CBR,

captured in the Joint Position Paper of WHO, ILO and UNESCO (2004)
that defined CBR as “a strategy within general community
development for the rehabilitation, equalization of opportunities and
social inclusion of all people with disabilities. CBR is implemented
through the combined efforts of people with disabilities themselves,
their families, organizations and communities, and the relevant
governmental and non-governmental agencies.”

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CBR today is understood as a strategy to promote inclusion, rights and
equal opportunities for persons with disabilities to ensure inclusive
development. CBR practice has changed from a medical orientated,
often single sector (e.g., health or education), service delivery
approach, to a comprehensive, multi-sectoral, rights-based one,
focusing on the creation of inclusive societies where persons with
disabilities have access to all development benefits that everyone in
their communities enjoy.

The growth of CBR in different regions of the world is evident from a

WHO survey conducted in 2007: about 92 countries had CBR projects
and programmes: 35 in Africa, 26 in Asia, 24 in Latin America and 7 in
Europe (Khasnabis and Heinicke-Motsch, 2008). CBR Congresses have
been organised over the last decade in Africa, Asia- Pacific and Latin
America; regional CBR Networks have been established to sustain the
CBR movement through training and information exchange, and there
are plans to promote a global CBR network, initiated in Agra in
November 2012.

The CBR Guidelines of WHO (2010), based on the principles of the UN-
CRPD, and developed with active participation of DPOs, UN agencies,
governments and civil society organisations, are recognition of the
importance of CBR as a world-wide movement. The Guidelines attempt
to synthesise experiences from across the world to provide a unified
understanding of the concept and principles of CBR. The Guidelines
provide a structure for CBR planners and practitioners, based on which
they can develop activities according to their local context, needs and
resources.

WHO CBR matrix:

The WHO CBR guidelines published in 2010 includes five components

each having five core elements. The summary of which is stated
below:

Components Elements
Health Health Promotion; Prevention; Medical care;
Rehabilitation; Assistive devices
Education Early childhood care and education; Primary

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Components Elements
Education; Secondary and higher education; Non-
formal education; Lifelong learning
Livelihoods Skill development; Self-employment; Wage
employment; Financial services; Social protection
Social Personal assistance; Relationship, Marriage and
family; Arts and Culture; Recreation, leisure and
Sports; Access to justice
Empowerment Advocacy and communication; Community
mobilisation; Political participation; Self-help
groups; Disabled people’s organisations

4. What is habilitation and rehabilitation for persons with visual

disabilities?

“Habilitation and Rehabilitation is a process of enabling the person with

visual disabilities to retain or regain residual sight, functional abilities,
skills and confidence in order to participate effectively in society on an
equal basis with others”.

5. What is CBR for persons with visual disabilities?

CBR is a strategy within community development for rehabilitation,

equalisation of opportunities, promotion and protection of human
rights, holistic development, empowerment, full participation and
inclusion of all persons with visual disabilities. CBR strives to provide
rehabilitation services to persons with visual disabilities at the
doorstep within the community where persons with visual disabilities
live.

CBR attempts to involve persons with visual disabilities, their families,

service providers, and community members in the rehabilitation
process at all levels. It makes a conscious attempt to raise the level of
awareness and change attitudes of all players towards persons with
visual disabilities. Mobilising local resources, knowledge, expertise and
skills is one of the core strategies of CBR.

On the other hand, Institution/Centre Based Rehabilitation (IBR) is

located in cities and towns which may be far from the families and
communities of persons with visual disabilities. It is a residential

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centre where persons with visual disabilities are provided with training,
education, vocational training, health, and medical rehabilitation
services. They may need to leave their families and communities for a
longer period depending on the purpose of the rehabilitation and will
often live with their peers. Community interaction may be limited
depending on the nature of the Centre.

As noted above, inclusion, standardization and quality are essential

principles in the provision of rehabilitation whether provided in a
community or centre based setting. The fundamental principles of the
UN-CRPD, and in particular, those reflected in Article 26 dealing with
rehabilitation, must be respected.

6. Position statement

6.1 We re-affirm our solemn commitment to improve the quality of

life of persons with visual disabilities, particularly those who live
in developing countries which have been facing a resource crunch
for the rehabilitation of persons with disabilities in general and
visual disabilities in particular. The above stated commitment
motivates us to encourage our members to implement CBR
programmes in order to reach a large number of persons with
visual disabilities who have not yet had the opportunity to access
their rights and entitlements.
6.2 We strongly believe that CBR is one of the alternative approaches
to reach a large number of persons with visual disabilities in
unreached areas but that this is not the only option. We strongly
dispute against those initiatives titled as CBR which grossly
compromise the quality of services and violate the human rights
of persons with visual disabilities. We believe in changing the life
situations of persons with visual disabilities but not just the mere
approaches or strategies. We strongly support inclusive
approaches and strategies which promote effective and
meaningful inclusion of persons with visual disabilities with
enhanced quality of life conditions.
6.3 We encourage our members to ensure that the following
elements and components should be integral parts of any CBR
programmes which they implement.

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7. General elements and standards

7.1 All CBR programs should comply with the operational framework
to implement the provisions of UN-CRPD and should be in
absolute compliance with the purpose, spirit, standards and
principles of the same;
7.2 All CBR programs should be in compliance with the goal,
purpose, components and elements of WHO CBR guidelines
-2010;
7.3 All Persons with visual disabilities should play an integral role in
any CBR programmes through their active participation and
involvement right from the design to evaluation stage at all
levels;
7.4 All CBR programmes should adopt multi-dimensional, multi-
sectorial and multi-disciplinary approaches and strategies;
7.5 All CBR programmes should extensively apply human rights
based approaches in all aspects and at all levels;
7.6 All CBR programs should strive towards the reduction of chronic
poverty conditions and address the power imbalance experienced
by persons with visual disabilities;
7.7 All CBR programs should extensively use advanced technology
including information technology, modern science and qualified
professionals to improve the quality of life of persons with visual
disabilities;
7.8 All CBR programs should recognize the multiple factors of
marginalization and exclusion which children, women/girls, older
persons, ethnic minorities, indigenous and other groups of
persons with visual disabilities face and should devise specific
strategies to address their issues and concerns;
7.9 All CBR programs should capitalize on local knowledge and
indigenous technology extensively;
7.10 All micro intensive CBR interventions should have extensive
macro impact for the benefit of a large number of persons with
visual disabilities through addressing systemic and structural
issues and policy changes;
7.11 All CBR programs should critically engage state, corporate and
civil society agencies towards achieving convergence and
maximize the impact;
7.12 All CBR programs should significantly contribute to the larger
antipoverty movement through building alliances with other
excluded and marginalized groups;

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7.13 All CBR programs should ensure transferability, scalability and
sustainability of development actions and processes;

8. Core components and elements

8.1 CBR should promote eye health care and prevention of avoidable
blindness through early detection and intervention measures;
8.2 The CBR team should include professionals such as
ophthalmologist, refractionist, orientation and mobility instructor,
Braille teacher, independent living specialist, psychologist and
other relevant professionals;
8.3 The CBR team should equally include blind and partially sighted
persons who can provide peer support, encouragement, practical
skills and information and link CBR participants to other blind and
partially sighted persons who can support their rehabilitation
process;
8.4 CBR should strive to improve the functional abilities of persons
with visual disabilities through intensive training on sensory
development, orientation, mobility, life skills, home
management, business development and management, banking
and financial management;
8.5 Provision of appropriate and adequate assistive devices and
technology such as white canes, spectacles, low vision aids,
braille kits, screen readers, guide dogs, personal assistants,
materials for reading, writing and other transactions;
8.6 Promotion of livelihoods through skill development, training in
soft skills, provision of initial capital, career counseling and
guidance, job placement and other employment services;
8.7 Facilitating persons with visual disabilities to organize in to
groups and federations for lobbying effectively with the local
administration and policy makers;
8.8 Facilitating recreation, leisure, sports, games, culture and arts
through appropriate and modified activities and materials.

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APPENDIX “A”

WBU Definitions of Rehabilitation

All individuals have the right to exist in a community where they can
participate in all aspects of life; work, independent living, education,
recreation, and the culture and events of the community. The aspects
of life most of us take for granted. Rehabilitation services help
individuals who are blind or partially sighted to fully participate in
those aspects of life to the best of their ability. This usually includes
training in how to live independently; dealing with transportation to
and from work, the market or other destinations; developing social
skills to deal with the general public; taking part in the political
process; and becoming fully integrated and involved in the community.
Rehabilitation services are about developing tools for life and the
ability to make use of those tools.

Key elements of rehabilitation services for people who are blind or

partially sighted include:

Travel Training Services (Orientation and Mobility)

 Spatial orientation and concepts
 Traffic awareness
 Travel safety
 Sighted guide techniques
 Training in the use of a long white cane
 Guide dog awareness
 Outdoor travel practice in a variety of environments

Activities of Daily Living Services (Independent Living Skills)

 Personal management, including grooming
 Home management, including cooking skills
 Communication skills, including reading and writing braille
 Development of recreational skills
 Money management

Adjustment to Blindness Services

 Peer support
 Vocational counseling
 Avocational counseling

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 Personal and family counseling
 Understanding cause of vision loss and prognosis connecting with
mentors

Low Vision Services

 Low vision evaluation
 Selection of optical aids for near, intermediate and distance viewing
 Training with optical aids in a variety of settings

Technology Services
 Selection and training on mainstream technology
 Selection and training on assistive technology
 Computer training

Career exploration Services

 Vocational evaluation
 Vocational counseling
 Job readiness training
 Making eye contact
o Shaking hands
 Making a good first impression
 Dressing for success
 Job seeking skills
 Work hardening

Job training Services

 On-the-job training
 Vocational training
 Technical school and/or university training

Job Development Services

 Supported employment
 Job search
 Job leads
 Job coaching
 Job retention