I was engaged in Community-Based Rehabilitation (CBR) programmes from early 1980s till a few years ago. Over that period, I saw CBR change from a health programme to a multi-sectoral approach dealing also with education, occupation and empowerment issues of persons with disabilities.
In this write-up I want to briefly look at the historical evolution of CBR approach, and some of the key persons involved in it - I was fortunate to meet and work with many of them. I will conclude with a brief reflection about the future of CBR and the possible roles of new technologies in it. (You can click on the images below for a bigger view)
The image below has a volunteer from red cross visiting a woman with disability who had received a loan from CBR programme to buy a sewing machine, in Da Nang province, Vietnam (2010) - image by Sunil Deepak.
Origins of Community-Based Rehabilitation (CBR)
Through the Alma Ata conference on primary health care in 1978, Dr Halfdan Mahler, DG of WHO in Geneva promoted the community based approaches including CBR.
In the image below (from right) - Dr Halfdan Mahler, author (Dr Sunil Deepak), with Armando & Hani Serag from PHM, in Geneva, 2007
While Alma Ata was being planned, Einar Helander was appointed at the rehabilitation department of WHO in Geneva and asked to look at CBR. Over the next few years, Padmini Mendis (Sri Lanka) Anne Goerdt (USA) joined him. The three of them prepared what came to be known as the WHO's CBR manual, which came out in 1989.
The basic premise of the WHO CBR manual was that in rural areas and small towns, there were few rehabilitation professionals. Often, only families and communities looked after the children and adults with disabilities. The manual presented simple rehabilitation techniques with illustrations, which could be taught to the families, so that they themselves could promote their greater autonomy and well-being.
However, the question was who would teach the simple information explained in the manual to disabled persons and their families? During 1980s and 90s, two main approaches were developed to answer this question - (1) Existing community workers, especially health workers; (2) Community volunteers, especially persons with disabilities themselves and/or their family members. Those persons were supposed to receive training for 21 days.
Another important CBR manual was developed in 1987 by David Werner, titled Disabled Village Children. However, instead of working in the communities, he proposed setting up of resource centres, where children with disabilities accompanied by a family member came to learn and practice self-care, which they could later continue at home.
From Health focused CBR to Multi-Sectoral CBR
Around 1990-91, Dr Enrico Pupulin took the place of Einar Helander at the Rehabilitation department of WHO. He started consultations with other UN agencies including UNESCO for education, ILO for work & UNICEF for children, for their roles in CBR. As a result of these consultations, The first Joint Position Paper on CBR was drafted in 1994, which was updated in 2004.
The pioneers of CBR - from left - Enrico Pupulin, Einar Helander & Alana Officer, at the CBR congress in Agra, India in 2012 - image by Sunil Deepak
In 2006, Disability & Rehabilitation (DAR) team of WHO under Alana Officer, together with UNESCO, ILO and IDDC, initiated a consultative process for the preparation of CBR Guidelines, under the guidance of Chapal Khasnabis. The CBR Guidelines came out in 2010. These guidelines proposed the CBR Matrix, a visual map to understand different components of CBR and their activities.
The term, Community-Based Inclusive Development (CBID) was proposed as an alternative to CBR to express its multi-sectoral nature.
Some of the Key Persons in CBR
During the 1980s, 1990s and the first decade of 2000, important CBR programmes covering large areas or entire countries or regions were started. Some countries adopted CBR as the national rehabilitation strategy. The image below from 1995, shows some of the key persons known for their work in CBR.
The image above is from a CBR workshop in Rome, organised by AIFO-Italy in 1995, with some of the key figures who played a big role in developing CBR approach including Brian O' Toole & Geraldine Mason Hall (Guyana), Dr Ferial and Dr Rati (Indonesia), Bob Ransom (ILO), Maya Thomas (India) and Dr Tran Trong Hai (Vietnam) - Image by Sunil Deepak
CBR & New Technologies in Last 15 years
Over the past decade, the diffusion of internet and smart phones across the world has changed the situation in terms of accessing information. For example, the video-platform YouTube is full of videos made by persons with disabilities of all kinds, by their families and by professionals, from around the world. These videos can be automatically translated and have subtitles in different languages.
Another example of technological change is the role played by social media and apps in connecting people and families and services.
Another change has been the predominant role of Organisations of Persons with Disabilities (OPDs) in the countries after the adoption of the International convention CRPD at the UN in 2006.
Compared to a health worker or a school teacher or a community volunteer, who had to be trained over 2-3 weeks in basic rehabilitation approaches to different kinds of disabilities, today the access to that kind of basic information is even more effective because individuals can connect with other families facing similar challenges.
Some years ago, together with International Disability and Development Consortium (IDDC), there was an effort to create a mobile app to provide the basic rehab information to CBR workers, through an app called RehApp. I tried looking for it on the Google store (in July 2026), found 2 apps of that name - one had been downloaded less than 100 times and the other around 1000 times.
WHO also has more than 20 self-learning modules on the TAP platform, which can be used for training health workers and others about different disabilities and assistive technology needs.
A Question to the CBR/CBID Programmes
My impression is that due to all these changes over the past decade, the CBR programmes as they existed up to 10-15 years ago, are no longer there. To understand the present situation, I have 3 questions for individuals and organisations that work with persons with disabilities:
(1) Is a CBR programme still useful? For doing what?
(2) Compared to 10-15 years ago, how have CBR related work changed?
(2) What roles are new technologies (including social media, whatsapp, messenger, youtube, etc.) playing in your work today?
You can answer by leaving a comment below (you can answer in English, French, Portuguese, Spanish, Hindi, Bengali or any other language that you prefer). Looking forward to hearing from you!
If you wish, you can also send me an email at sunil.deepak@gmail.com
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