COMMUNITY BASED REHABILITATION

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• COMMUNITY BASED REHABILITATION

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Introduction

• 600 million disabled in the world
• 15-20 of poor in developing world
• Disabled often stigmatized and excluded
• Dependent on others for physical, social and
  economic support
• Increasing numbers because of conflicts, wars
  accidents violence

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• Disabled are disproportionately poor and the
  poor disproportionately disabled
• Disability is not merely an attribute of the
  individual but a complex social and environmental
  construct imposed largely by societal attitudes
  and the limitation of the manmade environment

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Definition

• A strategy within community development for the
  rehabilitation, equalization of opportunities and
  social integration of all people with
  disabilities....

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• CBR is any activity which results from decision
  made by the community and their disabled persons
  in particular and which aims to enable disabled
  persons to gain more for themselves and their
  children of what they want and need...

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Concepts of CBR

• Awareness and concern of the community
• Initiatives from the community
• Planning by the community
• Implementation by the community
• Evaluation by the community
• Modification by the community
• Resources of the community
• Benefits to the community

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Common goals of CBR programs

• Empower disabled persons
• Inclusion of disabled persons in their home
  communities.
• Facilitate early childhood education.
• Elimination of barriers, both physical and
  social.
• Education of all disabled children.
• Improving health of disabled persons.
• Improving job skills for economic independence.

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Scope of CBR

• Prevention of disabilities
• Earlier detection of disabilities and management
• Assessment of the felt needs of the disabled and
  family
• Individualised learning programmes
• Home based or neighbourhood centre based
  programmes
• Parental involvement
• Organisations of disabled people
• Equity and equalization of opportunities
• Social integration

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CHRISTIAN MEDICAL COLLEGES CONTRIBUTION TO
COMMUNITY ('S) HEALTH

• 1906 ROADSIDE CLINIC
• 1947 KAVANUR HEALTH CENTRE
• 1954 DEPT OF PREVENTIVE SOCIAL MEDICINE
• 1955 RURAL HEALTH CENTRE
• 1977 RUHSA

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• 1978 CODES
• 1986 EPIDEMIOLOGY RESOURCE CENTRE
• 1996 CONDUCTING INTERNATIONAL TRAINING
  PROGRAMS
• 1998 WHO - SEARO AWARD FOR PHC
• 2001 WHO COLLABORATING CENTRE FOR CBE

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STRATEGY

• PROVIDE HEALTH SERVICES WHICH ARE
• ACCESSIBLE
• AFFORDABLE
• ACCEPTABLE
• INTEGRATED -INCLUDES PREVENTIVE, PROMOTIVE ,
  CURATIVE AND REHABILITATION
• COMMUNITY PARTICIPATION
• EFFECTIVE REFERRAL SYSTEM

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SOCIO-ECONOMIC DEVELOPMENT PROGRAMS

• CRÈCHES
• WOMENS CLUBS
• SELF HELP GROUPS
• HANDICRAFT CENTRES
• WOMEN'S WELDING
• TAILORING EMBROIDERY
• AUTOMOBILE
• TRANSPORT
• FAMILY COUNSELLING CENTRE

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TRAINING

• RECOGNISED BY SEVERAL FOREIGN UNIVERSITIES FOR
  PROVIDING TRAINING
• PRIMARY HEALTH CARE
• COMMUNITY DEVELOPMENT
• INTERNATIONAL HEALTH
• TRAVEL MEDICINE
• RCH
• RECOGNISED BY WHO AS A WHO COLLABORATING CENTRE
  IN CBE AND PHC

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RUHSA Population 120,000 K V Kuppam
Block Started in 1977
SERVICES Health Social Development
Agriculture Animal Husbandry Economic
Development
Rural Unit for Health Social Affairs
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Set up in 1982 for Primary Secondary care of
the poor in Vellore Town Special focus on Urban
slums
Urban Community Health Services covers Vellore
block and adjoining areas
Low Cost Effective Care Unit
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• Aims to
• provide low cost high quality primary secondary
  medical care for the poor of Vellore
• Done by
• delivering outreach services and health education
  in poor urban areas
• operating a good referral system from primary to
  tertiary care with appropriate follow-up
• working with other GO NGOs to improve the
  health of the community

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URBAN COMMUNITY HEALTH SERVICES

• Volunteer based services for the general
  population

Health education
First aid referral services
General health screening camp
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URBAN COMMUNITY HEALTH SERVICES

• Need based services for people with
  disabilities using volunteers from the community

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Covers 119,000 population in Kanniyambadi
Provides services also to adjoining block of
Anaicut
CHAD - Community Health Development
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The Community Health and Development (CHAD)
programme

• Providing primary health care to a population of
  just over 100,000, spread out in the 82 villages
  of Kaniyambadi block.
• Basic health care in the village provided by
  Part Time Community Health Workers (PTCHW the
  Traditional Dai trained by CHAD), under the
  supervision of the Health Aides (also a trained
  woman from the village). The Health Aides in turn
  are supervised by the Community Health Nurses and
  a doctor.
• Monthly mobile clinics conducted in each village
  by a doctor-led team. During these clinics, 3 4
  villages are visited and 75-100 people are
  treated for ailments.
• Preventive health care such as immunization for
  children and antenatal checks for pregnant
  mothers.

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Identification of differently abled

• Health Aides visit the villages every week and
  Nurses every two weeks.
• During these visits, they seek out persons with
  disabilities and report them to the Occupational
  Therapist (OT) at CHAD.
• The OT then arranges for a home visit for
  assessment
• After assessment, a treatment plan is drawn up
  for all those with disabilities.
• A database is maintained of all potential
  beneficiaries.

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In the community

• Seventy percent of the identified disabled are
  treated in the community by the occupational
  therapist who trains the disabled person(s) or
  member(s) of the family.
• Other members of the team are called on to see
  the disabled person as the situation demands
• . If additional care is required the disabled
  person is referred to CHAD and/or CMC through
  established channels.
• By involving local school teachers and balwadi
  workers, attempts are made at integrating
  disabled children into balwadis and schools
  locally.
• At the village schools, similarly vocational
  rehabilitation is provided to deserving
  individuals by liaison with WORTH,SHARE, MVT and
  DDRO training centres.

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At CHAD

• Maintaining a database and reports of the
  disabled and their follow up in the community
• Involved in screening children at the
  immunization clinic for disabilities.
• Providing occupational therapy care and advice
  for patients admitted or referred during OPD
  services at CHAD.
• Interdisciplinary team rounds and meeting every
  Friday.
• Involvement in training personnel in community
  based rehabilitation programmes

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The challenge...

• Disabled persons in rural areas of developing
  countries have very little access to education,
  health, and vocational services.
• In countries that do offer these services, they
  are usually carried out in large cities which are
  difficult for disabled persons to access.
• Lack of community awareness and cultural
  attitudes also adversely affect the lives of
  disabled persons, especially in more isolated
  communities. 

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Barriers to use of ICT

• Affordability
• Accessibility
• Functional limitation
• Lack of skills
• Lack of literacy

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• ICT provides opportunities to the
• Rich
• Educated
• Urban
• Mainstream
• Can it increase the divide between the haves
  and have-nots

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The Challenge

• To use ICT creatively to level the playing field
  in economic social and political terms by
  impacting the lives of people and empowering them
  using ICT

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• ICT can affect health conditions in developing
  countries by
• Directly by increased and more efficient health
  care provision
• Indirectly by impacting social determinants of
  health

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ICT and health services

• Continuing education and lifelong learning for
  doctors
• Enhanced delivery mechanisms to the poor and
  underserved locations for variety of services
  including telemedicine
• Increasing transparency and efficiency of
  governance