2009 is a defining year for Community–Based Rehabilitation (CBR) as the 1^st Asia-Pacific CBR Congress [1]  was held in February in Bangkok, and the ILO/UNESCO/ WHO CBR guidelines[2] will be launched in December.  

2009 is also a significant year for The Leprosy Mission (TLM), as we begin redefining our strategies in each of the countries where we work. The plan is to have a new 5-year strategy for each of the implementing countries by the end of 2010. We aim to incorporate the relevant recommendations from both the congress and the workshop into our global and national strategies, as well as our policies and best practice guidelines.

Like disability, CBR is an evolving concept. ILO/UNESCO/ WHO define CBR as:

…..a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities [3]

TLM now sees CBR as a strategy with underlying principles, not a programme. This means that merely being involved in livelihoods is not enough to be called CBR, if the principles underpinning CBR are not followed.

Our work will vary depending on the context, but should still follow the principles of CBR

Inclusion

TLM is trying to be more holistic in our strategy which means looking at not only the physical disability but also the social background including poverty. Our aim being that development issues are foremost in the mind of project managers and we are promoting inclusive development. Inclusive Development is the process of ensuring that all marginalized/ excluded groups are included in the development process.[4]  TLM joined the International Disability and Development Consortium (IDDC) in May 2009, this is part of our global action plan to learn more about and contribute to inclusive development in our implementing countries. [5]

The twin-track approach is being encouraged in our projects in order to reduce stigma and combat exclusion. This means Exclusive leprosy work should gradually be opened up to include persons with non-leprosy disability while at the same time TLM projects should encourage the inclusion of persons affected by leprosy in general rehabilitation programmes. This was recommended by the workshop in Bangkok and the ILA pre-congress workshop at Hyderabad. [6]

Participation

“CBR is implemented through the combined efforts of people with disabilities themselves, their families, organizations and communities, and the relevant governmental and non-governmental health, education, vocational, social and other services” [7]

Too often, the community response to our projects is different from what we expected which points to inadequate understanding of what the beliefs are in a community, how they think and how they manage issues and problems (Knowledge, Attitudes, Practice or KAP).  

All our work needs to be based on a truly participatory needs analysis (PNA) in and with the community or target group. So we are disseminating PNA material and encouraging field staff to observe and learn from one another how to be more participatory.

Sustainability

We have to ask who / what are we sustaining? There is a risk that what we are really sustaining is our jobs as a community based programme / hospital. Positive sustainability is all about strengthening projects to become autonomous and independent of TLM. The goal should be that a community embraces CBR and learns to organise itself and find its own sources of funding for development

Empowerment

Where is the locus of power? [8] In CBR, the power of decision making should be with the community itself. In our community programmes, does the power stay with the health workers and so called experts? Have we recognised the need to really partner with persons affected by leprosy and their communities and hand over the power of decision-making to them?

TLM has a strong relationship with IDEA, ENAPAL, HANDA, HEED, and other organisations for people affected by leprosy. In general, their activities are focused on the promotion of human rights of people affected by leprosy. The UN Convention on the Rights of Persons with Disabilities (UNCRPD) [9] is an important tool for the promotion of the rights of persons affected by leprosy as is the UN Resolution on the Elimination of Discrimination against Persons affected by Leprosy and their Family Members. [10] CBR is part of human rights and human rights are part of CBR. At the moment in TLM we are not clear about the issue of rights and are in the process of developing a policy about it.

CBR Matrix

As an exercise, some TLM staff rated just how closely the work we do corresponds with the 25 boxes of the CBR Matrix.  The results showed that TLM was involved in all aspects of work related to health, education, livelihood and empowerment although not equally in all boxes.  Only 1 box in the social component was identified as a major focus in any of the projects we looked at, but TLM does support some partner organisations (such as IDEA) that are much more active in the social component and empowerment.

It depends on strategic considerations what kind of involvement TLM will have in a given country, depending on needs, opportunities and work already done by others.

How is TLM managing this shift from interventions to a strategy?

Through our Intranet (“TLM Connect”), through policy and position papers, in meetings and through on-line seminars (webinars), the CBR Principles and Matrix are being disseminated to TLM Supporting and Implementing countries to assist project development and M&E. The meaning and application of these concepts are being explained to both home and field staff.

TLM country offices are being asked to identify country-specific needs for technical support in the area of CBR and TLM will provide such support as appropriate

There are many reports (grey literature) showing the impact of CBR around the TLM world. We are looking at opportunities to re-write and publish these reports in journals to contribute to the evidence about the implementation and effectiveness of CBR.

Jannine Ebenso, Chartered Physiotherapist
The Leprosy Mission International
E-mail: janninee@tlmint.org

 

 

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Categories: Field Activities, Members