The word sustainability is derived from the Latin sustinere (tenere, to hold). Dictionaries provide more than ten meanings for sustain, among which support, bear and keep up. While there is currently quite some attention for CBR it is questionable if that attention will be sustained. In the world of development many ideas, concepts and approaches seem to come and go, with a near date of expiration. It is just over 30 year that CBR was formally ‘invented’ by the WHO and nowadays we see already strong sentiments against the concept. In order to be fashionable we need to talk now about Community Based Inclusive Development. Rehabilitation has become a dirty word and of course during the Soviet era rehabilitation was experienced as the restoration of a person who was criminally prosecuted without due basis. It did not lead to the rights and pleasures as described in the UNCRPD. An it is true that there are still plenty of countries – notably some of them are frequently mentioned as model countries of CBR – where those pleasures seem to be reserved for few people only. It amazes me often to hear people talking about conferences on CBR in countries with dictatorial and oppressive regimes and still CBR means to them empowerment, equal rights and opportunities, inclusion…! Do they really believe that CBR can truly take place in countries where it is like hell for those who oppose the (political or religious) system? Now back to sustainability of CBR. That was the topic I wanted to deal with but one can see how easily one can become distracted. In times of rapid advances we so quickly get distracted; diverted; derailed by the slightest obstacles in achieving our goals…
Sustainability of CBR is of great concern. CBR still seems to be the playing ground of INGOs. How many governments have committed themselves to a CBR approach? Many of those who did so in the early years of CBR lost the idea completely; others continue (to their credit?) but nationwide coverage is as far as I know absent even in the most centralist countries that long ago introduced CBR with a specific - often medical - focus, coverage is limited, quality is poor and systems are crumbling. The model CBR-countries (praise to the governments who made a commitment )see that systems may still be in tact but at ground level the motivation of staff and volunteers is dwindling as budgets are shrinking as soon as the donor world pulls out of these countries. Is the picture that bleak…?
As long as governments are not convinced about the importance of CBR; as long as INGO play the major role in CBR development; as long as we lack CBR systems development with steering from the top (national level) and allowing for bottom-up development (local level) CBR eventually will cease to exist. Just the change of terminology won’t help. Conferences and guidelines won't help. WHO and allied forces wake up from the (CBR) matrix and start living in the real world! Create awareness, lobby and help governments to develop CBR national and regional systems and structures, give guidance on manpower planning and make sure sufficient resources are being allocated. Concentrate on that was is important and use your influence and power to enable change. Make it reality for people with disability to exert their rights and thus ensure that public services – including rehabilitation services - become accessible to all.
- Huib Cornielje, 1.August 2013 -