CBR AS PART OF COMMUNITY DEVELOPMENT - Source

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CBR AS PART OF COMMUNITY DEVELOPMENT EDITORIAL WHAT THIS BOOK CANNOT OFFER This book is not a manual about CBR and cannot therefore be used in this way. Neither does it present the "right" way to develop CBR programmes. It describes what different people have done in different countries to overcome the barriers presented to them. It examines what appears to have worked and why, and what has not worked and why, in a variety of locations. While many chapters are in academic style and of an academic standard, other equally valuable chapters, are descriptive by nature and differ in style and presentation. The book's overall focus is on CBR and community development, so it does not explore in any detail other important issues such as monitoring and evaluation. WHO SHOULD READ THIS BOOK? The groups of people who will find the content of this book useful are those who are interested and involved in the development of healthy equitable communities. This includes communities who seek to provide an environment that enables people with impairments and their families to maximise their own potential, to improve their quality of life and have the same opportunities and responsibilities as people who do not have impairments. Such people may be part of a family who have a disabled member or belong to the general community. They may be a member of an established professional group or a profession that is just emerging. These professional groups may be medically, socially or technically based; at an individual level they may be able-bodied or have a bodily impairment, they might be parents of children who have an impairment, or be members of a disabled people's organisation; or they may be politicians or personnel from funding agencies. They may be academics, trainers or programme managers. WHAT ARE THE KEY MESSAGES OF THIS BOOK? Three of the key messages have already been mentioned and are recorded in bold in the text above. They relate to poverty reduction being a major ingredient of CBR; the importance of sharing information, and disabled people themselves taking responsibility for their own development. The observation that "The Millennium goals cannot be achieved if they do not include disabled people" (particularly the goals concerning the eradication of poverty and the provision of education for all) is a real breakthrough in terms of putting disabled people and their families on the world agenda. However it is disturbing that the response to these goals are so slow in terms of implementation. For example disability is hardly mentioned in the UNESCO 2004 report on Inclusive Education. Interesting examples of the issues around this are found in Chapters 2, 3, 4 and 6. Chapter 9 addresses in some detail the absence of experimental (as opposed to experiential) evidence, on the efficacy (or otherwise) of CBR. This, it argues, is not only crucial to the future development of CBR but also something that CBR programmes themselves can make a major contribution towards in terms of making sure that research is grounded in reality. It was agreed that "The priority of CBR research needs to address local resources and participation." The absence of such data is a major concern, and undermines the credibility of CBR with service users, governments and funding agencies. CBR programmes are the best possible organisations to collect and provide this evidence. This is a real challenge to the readers of this book. In the previous section we discussed the possible representational meaning of the "R" in CBR. Ndaziboneye, Nyathi and Mzoma in Chapter 3 use the same approach to explore alternative concepts which could be represented by the 'C in CBR. They use this to highlight some of the limitations which have been experienced in the implementation of the CBR programmes such as "confusion" or "confinement" based rehabilitation. Many other practitioners also felt that "CBR should be more pro-active, and promote its activities aggressively to get other services in place," especially in relation to mainstreaming for education (Chapter 5), economic empowerment (Chapter 4), and for HIV/AIDS support and health (Chapters 6 and 7). The tendency for CBR programmes to be "re-active", and just "respond" to the problems that are presented is discussed. As a result CBR workers have become skilled at "problem solving" and "crisis management". There is a need for them to tackle the root causes of the problems, such as taking initiatives to get other agencies involved. CBR AS PART OF COMMUNITY DEVELOPMENT
One of the problems facing CBR stakeholders is how they can participate in the CBR process. In the past and still to some extent today, this uncertainty was experienced by disabled people themselves. The CBR strategy said they were to be involved. Further, they were to be key players, but what could they do? What exactly was their role? The disabled rights movement showed the way and now this is much clearer. Disabled people are recognised as the best people to raise awareness and set priorities. This is always apparent at any meeting where the messages conveyed by disabled people are so valuable and powerful in the political and professional arena. Now it is perhaps the turn of the health professionals to feel unsure about their role. At the WHO/CBR meeting in Helsinki, many professional felt dis-empowered by the "rights" approach and wondered what their role was in a rightsbased model of CBR. Of course the answer lies in appreciating the need for a comprehensive or universal model of disability and of CBR, which involves ALL stakeholders in a process that addresses medical, social, educational and equality dimensions of disablement. These observations and discussions led to the key message "CBR is for us all." This is sometimes a very difficult concept to operationalise, but the International Classification of Functioning and disability (ICF) is possibly one framework that might assist in this process. This is examined in Chapter 8. The development of CBR programmes based on local culture has been a feature of its history, often producing different varieties of CBR and initially leading to confusion over its definition and implementation. However it is recognised that some aspects of all cultures may be negatively disposed towards people with disabilities and that CBR needs to play a role in changing these negative elements (see Chapter 4). Recognising that "Aspects of culture that are negative cannot be changed overnight", as pointed out by Ndaziboneye, Nyathi and Mzoma in Chapter 3, this means giving information again and again in different ways. The technique is clearly demonstrated by big businesses such as Coca Cola. EDITORIAL A very active and contributing member of the Malawi conference was Ms. Gloria Kampondeni from Montfort Teachers College in Malawi. Gloria is a deaf teacher of the deaf and reminded the participants on many occasions of how often deaf people are excluded from CBR initiative and activities. She raised the members' awareness about the extent to which people with hearing difficulties are missed out. She challenged the gathering to examine their activities in relation to this factor and see how they could resurrect it. Two particular examples arose around the need for HIV information (Chapter 7) and their exclusion from research projects in Malawi (Chapter 9). The conclusion was that "CBR should make sure that deaf people are not being missed out." The need for CBR programmes to collaborate with teachers, to contribute to their training and to have an input to tertiary education are discussed in Chapter 5 and the relationship between this and economic empowerment of disabled people in Chapter 4 led to one of the final key messages that "CBR should promote education at ALL levels if people with disabilities are to have economic empowerment." This was also seen to relate to the need for CBR programmes to take initiatives and to be proactive. Programmes might ask themselves, how can they collaborate with teachers and contribute to their education? The problems that arise from difficulties in communication across the African continent were the subject of much discussion in the plenary sessions. These difficulties have created many barriers to the development of CBR programmes and on understanding the issues around having an impairment and the effect of this on the individual, their family and community. Good communication was observed to be seriously confounded in the first instance by the incredible number of different languages in each of the African countries (for example Nigeria has 521 and Kenya 61). This makes it difficult to develop countrywide programmes or produce local materials for information sharing, let alone communicate effectively across the continent. In the second instance there were serious problems with defining key terms such as impairment or disability. CBR words and concepts were not always translatable into local languages. It was concluded that "CBR needs to communicate its concepts in
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Page 3 and 4: International Classification of Fun
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Page 9 and 10: Alister Munthali Alister has an M.A
Page 11 and 12: Editorial Sally Hartley MLRR MPBOU
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