ANNUAL HEALTH BULLETIN 2004 - Ministry of Health

The integration of Community Based Rehabilitation (CBR) programme within the PHe
was commenced in 1997 (8th FYP) with assistance from WHO. The Community Based
Rehabilitation (CBR) Programme was initiated as a pilot programme in Khaling Geog,
Trashigang Dzongkhag, using the infrastructure of the primary health care system for
service delivery. This was aimed at identifying the challenges to include rehabilitation
as the fourth major component of Primary Health Care. With the experience gained in
the Khaling pilot programme, the CBR activities were gradually extended to other
dzongkhags.
Surveys carried out in the pilot CBR Programme and household surveys in Bhutan have
estimated disability at 3.5%. These figures are only suggestive and are not definitive. A
more detailed survey of the different regions may be necessary to correctly assess the
extent and degree of disabilities and their causes, which will be carried out soon.
However, the pilot survey has highlighted the fact that people with speech and hearing
problems constitute the highest percentage of the disabled population, followed by
those with visual impairment.
People with disabilities are often more severely affected by and exposed to, hardships
and discrimination than other community members. The most common needs expressed
by people with disabilities are for functional skills in daily life activities (self care,
mobility, behaviour), educational needs (schooling, vocational training) and needs for
information about their disability. Another major concern of people with disabilities is
the need for income generating activities.
In Bhutan, many superstitions and misconceptions about disabilIty continue to be
prevalent. Services for early identification and intervention to prevent the progression
of impairments and disabilities are insufficient, as also the facilities for medical
rehabilitation, education, awareness, and employment generation. The terrain in the
country is another challenge for delivery of rehabilitation services.
However, the pilot Programme has also highlighted the fact that the goals of a
community-based programme cannot be achieved only through the interventions of the
health sector. An effort has been made in the pilot phase to form a National Coordination
Committee on' Disability (NCCD) in 1999. Since then, the Ministries of
Education and Employment has started developing a policy for inclusion of people with
disabilities along with the mainstream of Bhutanese population in reaslising the
development philosophy of Gross National Happiness (GNH).