Newsletter 2014 Vol.2

Newsletter 2014 Vol. 2

Community Based Rehabilitation: gateway to paradise for some; a nightmare to others

The World Health Organization (WHO) formally initiated Community Based Rehabilitation (CBR) in the late seventies. Other United Nations agencies, such as the International Labor Organization, followed later, though they remained critical from the beginning and already in an early stage came with alternatives and rather suggested to look into Community Integrated Programmes.  Originally, Community Based Rehabilitation was based on the principles of Primary Health Care to address the (medical) rehabilitation needs of persons with disability in the Global South. It aimed to address the shortage of rehabilitation services for the majority of persons with a disability in lower income countries by providing services in, and with the community, using predominantly local resources. Community fieldworkers, with minimal training, offered basic, mainly medically oriented rehabilitation interventions. The focus was on strategies, which could be carried out by these workers, local volunteers or family members. The primary focus of Community Based Rehabilitation was to maximize individual functioning.

Community Based Rehabilitation as it has evolved over the past decades is different. Where CBR was initially dominated by the medical disability model it nowadays has evolved into a community development strategy that is aimed at participation of persons with disability in society, equal opportunities for all and inclusion of persons with disabilities. Community Based Rehabilitation is in fact a disability inclusive development strategy. Community Based Rehabilitation is increasingly recognized as an important instrument in implementing the United Nations Convention on the Rights of People with Disability and may play a very important role in achieving the newly formulated post-2015 Sustainable Development Goals. The current dominant CBR model is the WHO model, based on 10 principles, a matrix and a CBR guideline of 7 books weighing 2.2 kilogram. If the weight of the CBR guideline would be an indicator of the weight that is given by governments to CBR there is hope that it will become a sustainable model in meeting the needs of people with disabilities in the South. Yet, Community Based Rehabilitation still is viewed with lots of suspicion by for instance the – elite of the - global disability movement. The argument used is that CBR staff may be patronizing and playing an equal disempowering role as professionals usually did or do.
 
Less surprising is the fact that rehabilitation professionals are critical towards Community Based Rehabilitation as well. Haig et al (2009) state that Community Based Rehabilitation is a politically expedient way to allocate the least amount of funds possible to the problem. After all, uneducated villagers try to take control over the lives of persons with disabilities. They are cheaper than doctors and they don’t have the depth of medical knowledge to know what they’re missing. With no experts who understand the medical aspects of rehabilitation to advise or to advocate, and with WHO blessings, governments often give complete responsibility for rehabilitation to Ministries of Social Welfare, Education, Employment or Agriculture. Community Based Rehabilitation without specialized service provision is insufficient. The WHO and other policymakers need to recognize that, in every country with reasonable rehabilitation services, the medical programs are addressed by well-educated physicians who dedicate their careers to this cause’.
Haig et al (2009) clearly demonstrate that the medical establishment is still feeling superior and on top of the rehabilitation process. It is the classical resistance to change and the defense of professionals who fear to loose part of their power. Should however, rehabilitation professionals not have a more humble attitude in the rehabilitation and disability scene?  By doing so they could play an even more significant role in the lives and rehabilitation pathways of persons with disability! Should rehabilitation professionals not start with trying to understand the real life situations of people with disabilities and become servants instead of masters?

Is it not time to join forces and together ensure that poor people with disabilities in the South (not the elite!) will benefit from development and will have full access to public services?
Professionals: it is time to change your superior attitude in the rehabilitation scene! 
Wealthy, urban-based elitist (male) disabled people:  change your attitude too and give up your power base! Instead empower and serve those who have been powerless; those who live on the fringes of society in the slums and the periphery of the country!
Governments and NGOs: you too, change your attitude and start addressing the needs of the poorest of the poor and do realize that 20% of these people are people with disabilities!
 
A.J. Haig et al (2009) ‘The practice of physical medicine and rehabilitation in sub-Saharan Africa and Antarctica: A white paper or a black mark? Disability and Rehabilitation, 31(13), 1031-1037.

2014 English Courses

If you are looking for a CBR course; if you are interested in CBR and want more insights in CBR and its application; maybe even a critical view on CBR; if you are looking for an honest and practical perspective on CBR, then you have found the right course! From the 3rd to the 14th of November ALERT (Ethiopia) and Enablement (Netherlands) together will offer an International CBR Course directed at supervisors, directors, coordinators and others with an interest in CBR, disability and inclusion. The course will be conducted by 2 well-experienced CBR practitioners (Marieke Boersma and Huib Cornielje), having together over 40 years of CBR experience and a number of local trainers as well. They won’t inform you about the theory only! They will inform you about the practical application of CBR; the successes and the failures. They'll help you to reflect on your own practice. They won’t tell you the usual baloney! Invest in yourself; invest in your organisation!

The field of disability and development is in dire need of professionals with expertise in Monitoring and Evaluation. From 15 to 26 September Enablement will organize a brand new course in Nepal directed at managers, policy makers and evaluators to equip them with the required competencies to monitor and evaluate programs. Enablement is partner in the impact evaluation tool research project of the University College of London. State-of-the art insights into monitoring and evaluation will be addressed during this training.

Managers, policy makers and Government officials will benefit from Enablement’s Management and Leadership course for the purpose of planning, managing, evaluating and scaling up CBR programs. This course will be conducted in Leiderdorp, The Netherlands, from 6 to 17 October.

French Courses

Formation des Formateurs -TOT course
Enablement and CBM Niger will organize the very first French Training of Trainers in CBR in close collaboration. This initiative will contribute to the construction of a pool of dedicated and skilled trainers and facilitators in the field of CBR, which will enrich and support CBR developments in Francophone Africa. The course aims to improve training and facilitation skills for key staff working in the field of CBR. This course will be conducted in Niamey, Niger, from the 3rd to the 14th of November. The course curriculum and practical information will soon become available on our website.


The French language CBR Introduction Course that is going to be delivered in Burkina Faso beginning of July will be an in-company course for staff and project partners of Light for the World. This course is already fully booked.

Click here to find our updated training calendar.

Worldwide Developments

Enablement goes Caribbean!

We are currently involved in the initial CBR developments in the Caribbean region. A pre-conference CBR meeting took place on the 30th of April as part of the 59th annual Health Research Conference. Huib Cornielje was one of the keynote speakers. More information can be found on our website.

Contacts have been made with the Ministry of Public Health and the Ministry of Social Affairs of Aruba and meetings took place with their ministers to explore ways to assist Aruba in moving away from high-tech rehabilitation to more essential packages of rehabilitation: CBR is certainly an option that is being considered as a viable alternative to the existing – and too expensive – model of care and rehabilitation. 

High level training Members of Parliament Plateau State Nigeria

In June 2014 the first batch of students following the Diploma Course in Community Based Rehabilitation in Timor-Leste will graduate. Enablement designed the curriculum of this one-year course that is offered at the Universidade Nacional Timor Lorosa’e. A second monitoring and evaluation mission will take place in June and a new MOU between partners in Timor-Leste and Enablement will be signed soon.
 

During the visit to Timor-Leste a workshop will be given to the current batch of students in order to familiarize them with the use of a set of 15 so-called flashcards that are specially designed by Enablement. The purpose of these flashcards is to enable fieldworkers to make a field diagnosis of a particular kind of disability, provide basic interventions and to refer appropriately. The cards are printed in colour and laminated. The flashcards for Timor-Leste are translated into Tetun. The English version will become available for other organisations as well. A sample of one flashcard can be found below.

Nigeria

The first semester of the new 2-year Diploma Course on Community Based Rehabilitation at The University of Jos in Nigeria has not yet started due to an unexpected strike of the staff of the University. It is expected that  the course will commence soon. Enablement in close collaboration with CREATE (South Africa) contributed a major part to the design of the curriculum. In January 2013 Enablement delivered the first two-week Training of Trainers workshop to Staff of the Department of Special Education and Rehabilitation Sciences (SERS) of the University of Jos. This programme is funded by NUFFIC. The second series of workshops supposedly to be conducted in May this year had to be cancelled because of the increased security risks both in Abuja and Plateau State. It is hoped that the situation will stabilize and that the training can be given at a later stage.
Parallel to this CBR curriculum other important developments are taking place in Plateau State where in May 2013 a Disability Rights Commission has come into force. In September 2013 a strategic workshop was held with the Disability Rights Commission. While buildings have been renovated, staff employed and budget been allocated there are long delays in making decisions in order to pilot and roll-out CBR in Plateau State. We are anxiously awaiting the formal implementation of CBR in Plateau State and do realize the serious risks in this development; for instance: increased violence and instability.

Nepal

In March this year the 11th International CBR Course has been conducted at BIKASH Nepal. Participants from Pakistan, India, Nepal, Nigeria, South Africa and Zambia highly appreciated the content of the training and our training approach. The best reward we could receive was formulated as follows: “You helped us discovering on our own”.

It is with much regret that we have to inform you that after 11 years of working together with BIKASH we had to terminate our partnership. There is no basis of trust anymore to continue working with BIKASH and as stated it is with much disappointment that we see no way to further invest in the development of a sustainable and thriving BIKASH. It does not mean that we terminate our plans for CBR capacity building in Nepal. With immediate effect we launched Enablement-Nepal
(see: http://enablement-nepal.com).
We hope to inform you in our next newsletter in more detail about these developments.

Bosnia-Herzegovina

Huib Cornielje acted as co-facilitator in a 3-day inclusion training for 10 youth organisation in Bosnia Herzegovina. This training was offered by Light for the World Austria. 

 

 

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