CBR Guideline 3rd Meeting Report (WHO)
CBR Guideline 3rd Meeting Report (WHO)
CBR Guideline 3rd Meeting Report (WHO)
Meeting was well attended by the invited experts and minutes of the meeting are as
follows:
1. Introduction
History Community Based Rehabilitation was introduced some 25 years ago.
WHO developed and published a CBR Manual "Training in the
Community for People with Disabilities", in 1989. The authors were Einar
Helander, Padmani Mendis, Gunnel Nelson and Ann Goerdt. It was one
of the most successful publications of WHO and in the disability world. It
ran 3 editions and got translated in more that 50 languages. This manual
is still being used in the field quite extensively. It was a great occasion
as three of the 4 writers of the manual were present in the whole
meeting and contributed actively for the future development of CBR and
CBR Guidelines.
CBR Joint In 1994, ILO, UNESCO and WHO issued a Join Position Paper in order
Position Paper to provide general guidance for policy makers and practitioners of CBR .
In 2003, WHO organized an International Consultation to Review
Community Based Rehabilitation in Helsinki, hosted by the Government
of Finland. Mandated by the Helsinki Consultations, ILO, UNESCO and
WHO issued a revised Joint Position Paper in 2004. It described CBR as
a strategy for Rehabilitation, equalization of opportunities, poverty
reduction and social inclusion of people with disabilities. The document
updated the CBR concept and called for action to promote the rights of
people with disabilities. The Joint Position Paper identified CBR as a
multisectoral developmental intervention that both improves the lives of
people with disabilities and promotes the development of the
communities where they live.
CBR In order to build a bridge from policy to practice, WHO initiated the
Guidelines process in developing CBR Guidelines in close collaboration with the
1st Meeting key stakeholders. The first Guidelines Meeting, in November 2004 was
01 - 02 attended by 65 experts representing UN organizations, National
November Governments, Disabled People's Organizations, leading International
2004 Nongovernmental Organizations, Professional Organizations and
experts from developing countries and people with personal experience
of disabilities. The Meeting developed the basic framework for the new
Guidelines. The framework was summarized in a matrix of five
components: Health, Education, Livelihood, Empowerment, and Social.
Each component was divided into five elements. Human Rights, socio-
economic Development and an inclusive society were identified as the
goals of CBR. The basic principles guiding CBR were participation,
inclusion, sustainability, and self-advocacy. The 1st Meeting developed
the draft Contents of the Guidelines and identified the steps to be taken
for developing the guidelines further.
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2nd meeting Agreed that Guidelines would be a joint document of ILO, UNESCO and
25 - 27 July WHO to reflect the spirit of CBR as a multisectoral approach. An
2005 Advisory Group was established as the highest level guiding body. A
Core Group responsible for developing the contents of the Guidelines
was nominated. The contents were reviewed and updated. The Matrix
was revisited and adjusted accordingly. Lead authors for the
Components and other chapters were selected. Ms. Karen Heinicke-
Motsh was assigned the task of chief Editor. Chapal Khasnabis will
coordinate the whole initiative. The next steps, time line, the budget and
long term goals were discussed and agreed upon.
3rd meeting This was attended mostly by the Core Group Members. The preamble
05 - 09 of all the 5 components were drafted and shared. Responsibilities of
December leading various components were shared e.g. Livelihood - Kamala &
2005 Bob, Social - Cindy, Venus and Kathy, Empowerment - Venkatesh &
Derek, Health - Ann, Aline and Francesca and Education - Sue &
Roselyn. Authors list for the elements got finalized and it was decided
that following persons would coordinate with the authors and lead
authors to complete all the elements under each component e.g.
Livelihood - Bob, Social - Kathy, Empowerment - Venkatesh, Health -
Ann and Education - Sue. Core group members finalized the list of
authors and the Guidelines for the authors. Tentative plan of actions to
prepare the first draft of the Guidelines for the next meeting was chalked
out. It was decided that efforts will be made to complete all the additional
chapters by 2006 except introductory chapter which will be written at the
end.
2. Proceedings
CBR The purpose of the 4th meeting was to finalize each Chapter of the 1st
Guidelines draft of the CBR Guidelines. Additionally, it was also to decide on
1st draft layout, printing and a number of open issues such as some titles, styles,
glossary, timetables, cost factors and design a future plan of action.
Furthermore, the meeting was to address the dissemination strategy,
fundraising strategy and possibilities to develop training packages for the
practitioners. The meeting was composed of two parts. The first three
days it was attended by the CBR Guidelines Core Group and the two
last days were a combined meeting of the Core Group and Advisory
Group members.
Political The Director of VIP, Dr. Etienne Krug mentioned the two central
Commitment elements of the Work Plan of DAR, the CBR Guidelines and the World
Report on Disability and Rehabilitation. Dr. Federico Montero, Disability
and Rehabilitation (DAR) Team Coordinator opined that there was an
evident need for such Guidelines in the field and this need transpired
clearly at the first Continental Congress on CBR that was organized in
Chile 22 -24 November 2006. The representatives of ILO and UNESCO
expressed their organizations' commitment and full support to the joint
effort. They also referred to the adoption of the new Convention that was
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on the agenda of the UN General Assembly during the week and that
would, once ratified, further highlight the rights-based approach to
disability. All the stakeholders expressed their solidarity and expressed
their interest to develop it and promote it. Venus on behalf of Disabled
Peoples International (DPI) and William on behalf of International
Disability Alliance (IDA) also expressed their support.
3. Background
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A discussion group on training was established to work on the issue
after the meeting sessions. The Meeting was also reminded that WHO
follows high academic standards. CBR Guidelines need to go through an
academic review before publishing.
Challenges It was pointed out that most of the lead authors did not follow writing
guidelines. Component coordinators had too much work to do in order
to achieve some cohesiveness across elements. Until now, editing work
had focused exclusively on the element and component level rather than
on the book level. As a result, the first draft did not yet present a
consistent voice and the consistency needed.
Points for The main focus of the meeting was on joint group work and discussions
discussion to produce the next version of the Draft Guidelines. A preliminary draft
was available in the web and a paper version was distributed at the
meeting. In addition to the components, following issues were identified
for further discussion:
Agreement Preambles for each component do not need to discuss goals, purposes
and outputs. It is however useful to reflect on expected outcomes.
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Checklists are not necessary but can be used.
All chapters will be ready for editorial review by 31st of January 2007.
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There is also overlap that needs to insurance and the provision of
be addressed. insurance which covers costs of
assistive devices, etc.
Item on resources and
stakeholders is obviously Editing should ensure that no
redundant in the component. contradiction remains between
education component and health
Age related disability also need to component in relation to early
be discussed. childhood development.
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The place of lifelong learning
should be reconsidered.
Livelihood The chapter is still too theoretical. Reorganizing the chapter needs to
The theory should be translated be considered.
into practical strategies and
activities. The term 'Income generation’
should be revisited. An alternative
Goal, purpose and outputs should would be ‘self employment’.
be left out of the Preamble.
The order of items should be
The linkages with mainstream changed to reflect ‘skills
livelihoods need to be development’ and ‘financial
strengthened in order to build services’ as tools for employment.
clearly in the goal of CBR towards
mainstreaming people with ´Social protection’ should be
disabilities. placed as the last element.
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Social protection element needs
clarifying examples.
Social Much work is still needed as the The title of the social component
component is at this stage rather should be revisited. For the time
unorganized. being "Social" can be retained.
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Empowerment There is repetition due to In the matrix, Empowerment to be
commonalities across the the last sector in place of Social.
elements.
The component could be
The crosscutting themes might go reorganized e.g. in the following
better into the preamble rather sequence:
than repeating them throughout • Social mobilization;
the elements? This would lengthen • Political participation;
preamble and shorten the • Communication;
elements. • Self help groups (SHGs);
• Disabled People's
Concepts and strategies can be Organizations.
dealt with together rather than as 2
separate sections. There is a need for both short
examples and case studies for the
Empowerment preamble should elements.
deal with the distinction between
organizations ‘of’ and those ‘for’ Information about advocacy and
people with disabilities self advocacy children with
disabilities should be added.
Some elements have step-by-step
guidance. Consider whether all Empowerment, social, livelihoods
elements should be handled this and health chapters have
way or would that make the interconnections and these shall be
message too prescriptive. addressed in a coherent way.
Consider dropping the discussion
on the history and existing
contradictions.
It is recommended to use of
examples throughout as the
purpose of these Guidelines is to
provide theoretical base as well as
practical things to do.
Management, Management and evaluation are The evaluation chapter was joined
Monitoring placed in a supplement as with the management chapter.
and separate chapters each. Their New contents on monitoring were
Evaluation place and role and included.
interconnections need to be
reconsidered. At this stage there are four
elements: Planning; Resource
Discussion on training, evaluation, management; Leadership;
participatory approaches to Monitoring and evaluation.
planning should be included
There is a need to flag
There should be a clear management issues in all the
description of how to come up with components.
indicators
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It might not be functional to include
'training' in the management
chapter.
An outline of the outstanding issues and steps to be taken was presented to the meeting
for discussion. These included: Field testing, Global support group, Costs and fund raising;
Printing format; Translation; Timeline.
Field testing It was agreed that actual field testing of the guidelines would be too
demanding given the time and resource constraints. "Field validation" or
"peer review" was seen as a more appropriate notion for the review of
the Draft Guidelines by the relevant stakeholders. It was agreed that a
general framework and issues list would be developed by Core Group
leaders and WHO to focus the validation. The actual process would be
conducted by partners, particularly the International NGOs that have
close contact to the CBR management at various levels and in various
regions. Disabled people and their organizations would be closely
involved. Only English version will be available for field validation but
organizations could translate it in local languages as and when needed.
Global Concern was raised on the sustainability and the need for longer term
Support partnership around the implementation of the guidelines. For the time
Group being the Core Group would serve as the focal point until the Guidelines
are launched. More permanent structures would require a clear program
that would need to be developed.
Costs The total need for funding is estimated to be about 1 Mill USD. Half of
the sum is needed for translation and printing. Printing will be done
through a global tendering process. There will be a tradeoff issue
between cheaper printing costs and costs of handling and mailing.
Fundraising Project has been funded by WHO and voluntary contributions by CBM,
Sightsavers International pledged to make contribution in 2007 and
2008. ILO also made a definite commitment for 2007 and 2008.
International NGOs are also paying for their staff or consultant who are
associated with this work.
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understanding between WHO, ILO and UNESCO that the organizations
should mobilize funds into the pool. It was also agreed that the
establishing of a subcommittee for funding should be considered.
31 May 2007 2nd Draft complete (edited form contents and style)
Case study guide, photo guide as well as field
31 May 2007 validation plan and questionnaire complete
June-September, Field validation
2007
October 2007 Chief Editor compiles field feedback, photos and
case studies for the Core Group
1-3 November, CBR Africa Conference in South Africa
2007
November, 2007* Core Group and Advisory Group meet; Core Group
analyzes feedback and Advisory Group prepares
the message to policy makers
Editor incorporates feed back, photos, line drawings
and case studies
31 December, 3rd Draft complete
2007
January-March, Peer Review
2007
April, 2008 Core Group and Advisory Group analyze the Peer
Review feedback
31 May, 2008 Peer Review feedback incorporated, 4rth Draft
complete
June- November, Layout and printing
2008
3 December, CBR GUIDELINES TO BE LAUNCHED
2008
7. Conclusion
At the final session of the meeting it was agreed that the purpose of the meeting was well
fulfilled. The relevant issues were discussed and resolved and solid and precise
agreements had been reached to guide work forward. There was work to be done, but the
plans for next steps were clear and manageable.
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The Chief Editor thanked the participants and the DAR team for excellent collaboration
and support in her work. The Chairperson of DPI assured that the cooperation had been a
very good experience also for people with disabilities and their organizations and that the
collaboration would continue intensively in this and other joint operations. The meeting
participants extended their appreciation and warm thanks to the Coordinator of WHO/DAR,
Dr. Federico Montero, to Mr. Chapal Khasnabis, Ms. Margaret Naegeli and the whole DAR
team for the devoted and successful effort to keep the process moving and on the track.
The Coordinator of WHO/DAR expressed his gratitude for the professional effort everyone
had invested in this joint work. He also recalled the great impact the first CBR Manual of
1989 has had for the benefit of people with disabilities and expressed his appreciation for
the work the authors of that Manual have done those days, thereafter and also in this
process of drafting the new Guidelines on CBR. While his term as DAR Coordinator was
coming to an end he assured full and intensive collaboration in this project and in the
future.
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