Difference between Institution based and Community based rehabilitation

1. Institution-based rehabilitation: In Institution-based rehabilitation, the Focus of control is

based in the institution. This service meets a small number of needs of a small number of
disabled people. This is at best a limited approach, and at worst it can abuse the rights of disabled
persons.

2. Outreach programme: With Outreach, the locus of control is still based in the institution.
More people can be ‘reached’ but there will be limits according to distance from the institution,
and according to whether the needs of the disabled people are similar to what the institution
offers.

3. Community Based Rehabilitation: With CBR, the locus of control should be with the
community. So the starting point is exactly the opposite. The disabled people, family and
community members decide what their priorities are, and then work together with local
organizations, government, institutions, in order to access the relevant and appropriate services.
Institutions have an important role as referral agencies. The difference is that they respond to
needs rather than dictate them.

Community Based Rehabilitation Institution Based

(Medical)Rehabilitation
Based on Social model and Human Based on Medical Model
rights model
Concept of capacity building and Concept of treatment – Prescription
empowerment
Person with disability will be the Professional is the decision taker
decision taker
Utilization of available resources in Utilization of professional service
their own community delivery model
Targeted for larger population Target of smaller population
Minimal medical service / Basic High tech medical services
services
Economic status of people with Economic status is big barrier for getting
disability is not a barrier the services
Team member include person with Team member include person with
disability, parents, care givers, family, disability, physician, physiotherapist,
local community, NDGs, Voluntary speech therapist orthotics and prosthetic
organizations, Governments… technician, music therapist…(Change
(Change according to the cultural / according to the medical condition)
context )
What is CBR
flexible
active involvement of families and communities
a partnership approach with disabled people and
parents of disabled children
capacity building of disabled people and their
families, in the context of their community and
culture
holistic in its approach to disabled people;
addressing social, employment, educational, and
other needs not just physical multi-sectoral
an approach which uses centers/institutions to
respond to the needs of disabled people and their
families
a system which is based in the community, but
which uses district level and national level
services for referral
an approach which aims to enable around 80% of
disabled people’s rehabilitation needs to be
addressed in the community
integrated into existing services and promoting
the social inclusion of disabled people
an approach with a broad concept of
‘rehabilitation’
a long term strategy
What is not CBR?
rigid or a blue-print
an approach which only focuses on the
physical or medical needs of a person
long-term residential care
delivering a service to disabled people as
passive recipients
only outreach from a centre
rehabilitation training in isolation
surveys on disability with no
action
limited to one sector
an approach which is determined by the
needs of an institution or group of
professionals
an approach which requires that
disabled people have to travel to
a remote centre or institution to
meet their needs
segregated and separate from
services for other people
an approach with a narrow
concept of ‘rehabilitation’
a short-term fix