Rehabilitation in the community

12 World Health • 47th Year, No.4, July-August 1994 Rehabilitation in the • commun1ty Naomi Rumano Community-based rehabilitation (CBR) programmes are in principle multi-disability ori- ented and aim for joint multisectoral action at the level of the community, supported by an appropriate referral and supervisory system. Each pro- gramme implies the transfer of skills and knowledge of rehabilitation to people with disabilities, their fami- lies and their communities. It em- powers disabled persons and facilitates their social integration. It is estimated that the CBR approach meets the essential needs of 70-80% of all disabled people in the commu- nity. The remaining 20-30% of the needs have to be met at referral levels, including institutions. Community-based rehabilitation programmes aim: • to promote awareness, self- reliance and responsibility for rehabilitation in the community; • to build on local manpower resources in the community, including disabled persons, their families and other community members; • to encourage the use of simple methods and techniques which are acceptable, affordable and appropriate to the local setting; • to use the existing local organiza- tions and infrastructure to deliver services, especially primary health care services, but also labour and social services includ- ing the education system. Families who take care of chil- dren or adults with disabilities often face a lack of understanding about This young woman, despite her disability, has sewn a child's dress with her feet. the disability as well as negative attitudes within the community. Because of heavy workloads, partic- ularly during planting or harvesting, family members have little or no time to spare to assist someone with a disability. CBR addresses these problems and gives support to fami- lies so that they can be active in a rehabilitation process for a family member with a disability. The CBR programme may conduct public meetings to raise awareness about the causes of disability and the po- tential abilities of disabled people. It trains community workers who visit and advise disabled people and their families , and it encourages support from the community for those fami- lies. It also includes supervision from district level rehabilitation workers who visit homes where there are problems which cannot be handled by the community worker. Achievements in Zimbabwe A CBR programme in Gutu District of Masvingo Province, Zimbabwe, offers an example of what can be achieved. Fifteen self-help projects were started, and at the end of two years a total of 1087 disabled persons had been assessed: - 900 were on training programmes, and 316 of them were making good progress; - 68 had completed training and were discharged as functional; - 82 had achieved social integration at home, within families and in schools; - 6 were able to get employment locally; - 500 had benefited from referral services; - 167 were receiving appropriate aids. • Mrs Naomi Rumano is a CBR Consultant working in Harare. Her address is: 33 Hedsar Drive, Borrowdale, Harare, Zimbabwe.