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The 3rd Asia-Pacific CBR Congress

Evaluation of Community Based Rehabilitation from Gender Perspective

Ummul Kher
New Delhi, India

The concept of Community Based Rehabilitation was developed by the World Health Organization in 1970s to provide the rehabilitation services to persons with disabilities. High disparity and complicated bureaucratic system in health care encouraged WHO to develop this alternative, decentralized system to bring the health care benefits at the doorsteps of the most deprived among all. The CBR model was inspired by the WHO’s Primary Health Care Model (PHC), which aimed to utilize the locally available resources and personnel to provide basic rehabilitation and medical services at lower cost and higher efficiency. Thus, idea of CBR emerged at 1978’s International Conference on Primary Health Care in Alma-Ata in USSR. At the time of its inception, CBR was considered as the ray of the hope for the developing countries who were not having enough resources to provide institutionalized medical and rehabilitation facilities for their disabled population.

In 30 years, CBR has evolved from the rehabilitation oriented Medical Model to a more comprehensive model with a major focus on Human Rights. But the design of gender neutral CBR is engineered in the context of the local community so the not so good practices prevailing in most of the male dominated, patriarchic societies in developing countries sometimes overshadow its positive aspects.

Cultural sensitivity is considered as one of the most positive feature of CBR. Rather than imposing the foreign understanding of disability, alien to the local people; CBR tries to understand the cultural interpretation of disability at the local level and then design its projects accordingly. The human resource for the CBR program is generated out of local community members who not only understand the local culture, but are also integral agents for its perpetuity and continuity. And from here the problem starts. In the societies, where women are still treated as second class citizens, where their mobility is strictly restricted on the name of Purdah custom, where their worth is determined by number of male children they have produced and where they are given in arrange marriages to work as unpaid servants amidst frequent domestic violence and where a large number of women with disability are still illiterate and confined to their houses; CBR has failed to raise the issue of gender justice in a bold manner. It has succumbed to the local upper caste, elite male hegemony in developing countries, especially in South Asia.

Feminist disability scholars point out that many a times, in the disability movement, accessibility, employment, advocacy, rehabilitation, etc. are considered as masculine and hence necessary elements which require immediate attention, whereas relationship, marriage, family, skill development and empowerment, etc. are thought to be more feminine elements that consume time and hence can wait until the other serious elements are addressed. Though there is no dispute that marriage, family life, soft skill building etc. are as important as accessibility, advocacy, etc. but for the time being, if we borrow this understanding into CBR and its matrix’s application, we have to realize that a healthy balance between these hard and soft elements are the only way to guarantee gender sensitive CBR programs.

In order to understand the causes of failure of many CBR practices, it is imperative to understand the local cultural dimensions in a balanced manner. The role of women in the developing countries is twofold. First, in the labor intensive society, they are expected to bear a lot of children, especially the male children. However, women with disabilities are not considered suitable for marriage as it is widely believed that persons with disabilities, especially women with disability will give birth to disabled children. Secondly, persons with disability are considered as asexual and infertile. They are either considered as saintly persons without any physical desire or as hypersexual, sexually starved perverts. So in the social set up where sexuality is still a taboo, sometimes persons with disability, especially women with disability have to deny their sexual needs categorically, to get respect in the society. To address this issue, CBR matrix is already having the element of relationship, marriage and family. The only need is to give priority to this element so that its effect of its implementation can be seen in reality and it does not remain on papers only.

Secondly, women’s role in the economic activities in developing countries is very significant as sometimes they are solely responsible to generate income for their families. Women with disability are usually perceived as economically unproductive as gender and physical impairment creates a situation of double jeopardy, which restricts their ability to perform both gender as well as economic roles. If women become disabled due to frequent childbirths, malnutrition, heavy physical labor or any accident, the chances to continue their married life become very little. Women with acquired disability have very high rate of divorce and are usually abandoned by their families.

Women with disabilities are not considered suitable for marriage, but ironically, they are very susceptible to rape and sexual assault. Most of the time the perpetrator is of their acquaintance. As women are considered honor of their family, incidences of sexual assault further diminish chances of their mobility, education or accessing rehabilitation. Since women with disabilities don’t have much freedom to move into the community and they are not free to have fruitful social interaction, they cannot utilize their assistive devices and rehabilitation benefits beyond the four walls of their houses. The CBR programs must insure that the assistive devices and fruits of rehabilitation services are not restricted under the boundaries of the household rather their uses are channeled to make the lives of women with disabilities economically independent and socially respected.

Recently, acid throwing incidences has increased substantially in many parts of the world, but its usage against women is an alarming trend in the South Asian countries. In acid attack, acid or other harmful substances are thrown on the body of the person, especially on the face, with an intention to disfigure, disable or maim the person. It results in severe burning the skin tissue, often exposing and sometimes dissolving the bone tissues. Many a times, acid attack survivors become blind with gruesome scares on the face and body. CBR can play an active role in the prevention of such incidences by advocacy, communication and community mobilization. As the case of disability caused by acid attack is different and unique; the active role of CBR in the rehabilitation of acid attack survivors can fill a vacuum created by meagre compensation which government releases after painfully long bureaucratic file works and absence of social support.

Generally, there is a high rate of male employed as technicians, counselors and trainers in the CBR programs which reduces access of women with disabilities to necessary rehabilitation services. It is the time when CBR planners should balance their rehabilitation work with awareness campaign and gender sensitive attitude building so that women with disabilities can play significant role of trainers, workers and managers in the CBR program with full social acceptance.

There cannot be one CBR model or universally accepted CBR practice and, also, all communities are not the same; it is important to recognize that it is not good to have all decision making at the community level. The bottom-up initiatives of CBR must be regulated and monitored by the top-down approach wherever necessary so that the love of local community for their traditional customs and beliefs do not overpower rationality, need of equal opportunity and social justice. Government and concerned ministries must involve with the CBR program. The degree of involvement can vary from community to community and country to country.

Usually issues of women with disabilities are ignored in the disability movement as the disability movement has reduced to a male dominated arena where almost all NGOs, groups and significant organizations are headed by male leaders. But the plight is that the issues of women with disabilities are not raised by even the Women’s organization as women with disability and their needs are mistakenly considered as different from other women. Their identity of being disabled is taken into the consideration prior to accepting them as women. The CBR can become a missing link between disability and women’s organizations by sensitizing them about the rights of women with disabilities to get appropriate representation in both.

For the empowerment of women with disabilities, their political participation and active role in decision making are the most important conditions. There should be emphasis on the skill development of women with disabilities so that the dream of independent living can come closer to its realization. For years, CBR has dedicated its energy in the activities for the component Health and then gradually pursuing the issues of Education, Livelihood, Social and the component of Empowerment used to come at the last. But now is the time when CBR must reverse the order of matrix to make Empowerment as the first and most important component with the focus starting from skill development to advocacy, communication and community mobilization so that persons with disabilities not remain the receivers of the rehabilitation rather can actively take part in the creation of their future.


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