CBR Background

CBR Background in Afghanistan

CBR programmes in Afghanistan were developed in the 90-ies during a national emergency period with very scarce social and health services and at a time when there was general distrust of local government agencies. CBR programmes were implemented by international NGOs with technical support and coordination from UNDP. As a consequence the CBR programmes were developed with basic, but quite comprehensive home based rehabilitation services; later Community Rehabilitation and Development Centres – CRDCs – were developed in villages. Educated village people were recruited as community rehabilitation workers to do surveys and register people with disabilities in villages and to provide basic training for children with disabilities. In addition there were local physiotherapy clinics related to CRDCs or local health clinics. CBR programmes also had their own representative mechanisms, such as CBR committees. Most CBR programmes in Afghanistan are still implemented according to this structure.

After 2002, in spite of security problems, there are distinct changes in the national context with a majority of the provinces in Afghanistan in a reconstruction period with plans and efforts at implementation of development in all sectors. In this new context there is a need to change CBR programmes so that that they promote a more truly community based approach with ownership where it should be, namely at the local decision making structures, which at this time of reconstruction is gaining more confidence from the local population. This is also a time for development of a wide range of Community Based Organisations (CBOs), and among them Disabled People’s Organisations (DPOs). Local decision making bodies, shuras , should develop a more responsible role for CBR programme implementation.

As a consequence of the changes in the context of CBR programme implementation, there is a need to develop new roles, functions and responsibilities for CBR workers and volunteers so that they will be better prepared to support local development and advocate for participation and access for people with disabilities in the new development. CBR workers and coordinators have emphasised a strong need for updated and systematic training in order to be able to support this development. As a first step it is decided among the CBR implementers to have an assessment of needs for training, which should end up with recommendations for key contents for future training and indicate how future CBR training should be organised.

CBR programs are implemented in 16 out of 34 provinces (80 out of 364 districts), currently with 22 percent coverage around the country with some differences among the implementing organizations. There is a functioning informal coordination system between CBR implementers and with other development programs at district and community level. CBR implementers visit each others’ programs to get new ideas and compare good practices. CBR training including disability awareness is given for health care providers, teachers, and volunteers of various community development programs.

There is a need for more and upgraded training in basic CBR objectives and strategies for CBR program workers, volunteers and representatives in local decision making bodies (Shuras).

The INGO/NGOs who are implementing CBR are presently building up more information and referral systems with health facilities and specialist services such as audiometric services, plastic surgery and orthopedic surgery, governmental schools, and other existing services. But referral systems and the services themselves are still insufficient or lacking.

In February 2006, UNDP contracted a study of CBR , which resulted in the report “ CBR in Afghanistan – a report on the current state of CBR in Afghanistan ” by Coleridge and Dube. The report emphasized the need for more coordination of CBR programs and more cooperation / integration with general community development programs. Recommendations have been followed up by MoPH and MoLSAMD.

In November 2006 the first national conference on CBR was jointly organized by CBR implementers, other disability stakeholders, the UN and EC, with active participation by MoPH, MoLSAMD, MoT, MoE, members of the Upper House, as well as civil society groups. Based on recommendations from the 2006 conference the informal CBR Network was established in 2007.