Community-Based Rehabilitation is an Option to Address Challenges of Disabilities in India.

Dear Editor,

This is in reference to the article entitled “Disability and rehabilitation services in India: Issues and challenges” published in your journal.[1] This is a great article that highlights relevance of community-based rehabilitation (CBR) for people with disabilities. The prevalence of disabilities is higher in low- and middle-income countries compared to higher income countries.[2] However, recent studies are projecting even further raise in incidence of disabilities across the world as a result of changing disease trend from infectious diseases to the noncommunicable disease, increase in life expectancy, and better health facilities and outcome.[123] Countries with higher income have well-established and integrated system of identification and rehabilitation for people with disabilities. This system is lacked in economically poor countries.

People with disabilities in developing nations face a number of social, medical, educational, employment, and political challenges.[2] Availability of rehabilitation services and their delivery is very limited in India. In many cases, such services are confined to the cities.[4] A large percentage of people with disabilities live in poverty and in rural areas. They face manifold challenges. This population deserves services, but what are the options? Existing rehabilitation institutions in the area of intellectual, visual, speech and hearing, locomotor, and multiple disabilities cannot serve 2.2-6.3% of the disabled population of India.[1] Social implications of disabilities are more disadvantageous for people with disabilities; where these institutions are merely reaching.[4] So far, the CBR approach has been viewed as an option. Presently, the CBR approach has been practiced in around 90 countries.[56]

Many studies found that the CBR is a cost-effective, accessible, sensitive to the community needs, flexible, and an applicable approach in resource-poor settings. It has evidences of enabling and empowering people with disabilities and their communities.[2] Usually, the CBR program/s are conducted by nongovernmental organizations (NGOs) in India. The CBR programs in India mainly focus on four major components: Medical, educational, economic, and social. The NGOs further choose their focus area within four components depending upon the resources and capacity they have. Community organization/s may do a better job in increasing awareness and promoting better health practices by applying public health approaches in order to prevent disabilities and its negative outcomes.[1256] Current literature on the CBR advocates several benefits as well as many challenges. There is a limited information on the effectiveness of CBR, methodology, coverage, and its scope.[2] More standardization is needed. Looking at the magnitude and the burden of disabilities, the Indian government needs to honor the CBR approach seriously. The government should promote funding for the CBR programs, trainings, and research to make this model more effective and comprehensive. Academic community focusing in the areas of behavior and the health promotion of public health should synergize their research in the relation to the CBR.