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Community Based Rehabilitation (CBR)

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What is CBR?

"A strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disabilities"

By United Nations

"CBR is a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights"

By Einar Helander
Swedish PhD and M.D.
Internationally Recognized Expert on CBR

CBR is a strategy within general community development for rehabilitation, equalization of opportunities and social inclusion of all children and adults with disabilities. CBR is implemented through the combined efforts of people with disabilities themselves, their families and communities, and the appropriate health, education, vocational and social services.

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Technical advances and rehabilitation

Following World War II, many countries had large numbers of disabled servicemen who had survived serious injury due to medical advances and were able to reintegrate into their communities due to advances in technical aids, appliances and assistive technology. A new specialty, rehabilitation, rapidly developed and in subsequent decades became the subject of substantial international research, development and technical assistance by governments and international non-governmental organizations. A United Nations Rehabilitation Unit was established in 1951 to facilitate the transfer of these new medical and technical advances to developing countries.

Early attempts to spread rehabilitation to developing countries

The main aspects of this international assistance were the training of rehabilitation physicians and technicians, support for construction of large urban-based rehabilitation centers and the development of a professional team approach ranging from specialized physicians to nurses to psychologists to occupational and physical therapists to technicians who fitted appliances.  By the end of the 1960s it was becoming apparent that this approach to developing countries was resulting in minimal rehabilitation services being established in capitol cities but was not reaching the vast numbers of disabled children and adults living in the millions of villages and slums.

In response, meetings were held in 1969 by Rehabilitation International and in the early 1970s by the World Health Organization, the International Labor Organization and other concerned groups to explore alternatives.  In 1978, the WHO, facing similar challenges in extending primary health care to poor countries, adopted the Alma Alta declaration, shifting support from city-based hospitals and institutions to the community. According to WHO, “Community based rehabilitation evolved as a natural consequence of this initiative.”

Developing CBR through pilot projects

In the late 1970s and throughout the 1980s and 1990s numerous pilot projects were launched in developing countries in Africa, Asia and to a lesser extent in Latin America, under the aegis of CBR, some following the manuals developed by WHO, “Training in the community for people with disabilities,” others supported by ILO, UNESCO or UNICEF, with still others initiated by NGOs already working with disabled people in technical assistance projects.  A detailed history and explanation of the evolution of CBR, “Prejudice and Dignity: An Introduction to Community Based Rehabilitation,” was written by the main author of the WHO CBR manuals, Einar Helander.

CBR Global Review 2003

Twenty years after its introduction, a global consultation to review the state of CBR External Link icon (transparent) was called by WHO in collaboration with UN organizations, NGOs, Disabled People’s Organizations, hosted by the Government of Finland.  Held May 25-28, 2003 in Helsinki, it was attended by approximately 100 invited CBR practitioners and researchers from around the world.

The theme paper for the meeting noted that:

  • Because all communities differ in socio-economic conditions, terrain, cultures and political systems, there cannot be one model of CBR for the world;
  • The focus of CBR has evolved from medical rehabilitation towards more comprehensive multi-sector approaches such as access to health care, education, vocational training, income generation programs and community participation and inclusion; and
  • CBR is now being viewed as an essential component of community development

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Publications and Reports

World Bank Publications

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Last updated: 2010-04-15

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