ECONOMIC AND SOCIAL COMMISSION

FOR ASIA AND THE PACIFIC

UNDERSTANDING COMMUNITY-BASED REHABILITATION(*)

UNITED NATIONS
New York, 1998
ST/ESCAP/1761
Appreciation is expressed to Council of Disabled People of Thailand and DPI Asia Pacific Regional
Council printing this publication

Table of Contents

I. Introduction
II. The Multi-sectoral Approach
III. Programme Criteria
IV. The Components of Community-based Rehabilitation Programmes
V. Sectors and Roles for the Development and Implementation of Community-based Rehabilitation
VI. Summary

INTRODUCTION

This publication focuses on understanding community-based rehabilitation (CBR). It does not try to
define CBR, as it has become apparent in recent years that CBR defies definition. This is because its
simplicity and complexity have led to confusion about what CBR means. The simplicity of CBR has to
do with its history of starting with the delivery of primary rehabilitation therapy to people with
disabilities in their communities(1). The complexity of CBR is the result of the current concept that CBR
programmes should be multi-sectoral (or multi-disciplinary) so that they can provide assistance in all
of the areas which are central to improvement of the quality of life of people with disabilities. This
complexity recognizes the need for close coordination, collaboration and cooperation between
governmental and non-governmental organizations of all types and at all levels.

The basic concept inherent in the multi-sectoral approach to CBR is the decentralization of
responsibility and resources, both human and financial, to community-level organizations. In this
approach, governmental and non-governmental institutional and outreach rehabilitation services must
support community initiatives and organizations.
For the multi-sectoral approach to CBR to be successfully translated into action, both governmental
and non-governmental service capacities need to be improved in most countries of the Asian and
Pacific region. Of special importance is improvement of the capacity and skills for facilitating
community involvement. Such improvement and related activities must be closely coordinated to
ensure the optimum use of scarce resources. In accordance with the multi-sectoral concept, systems
are developed, at the community level and among governmental and non-governmental organizations,
that interact and reach out to each other.
Another factor for the success of the multi-sectoral approach is the empowerment of the community
to assume responsibility for ensuring that all its members, including those with disabilities, achieve
equal access to all of the resources that are available to that community, and that they are enabled to
participate fully in the social, economic and political life of the community. This approach ensures that
what is done in the name of CBR actually fits into the reality of the community and is owned by the
community.

THE MULTI-SECTORAL APPROACH

The starting point for understanding CBR is the following approach agreed to in 1994 by ILO,
UNESCO and WHO(2):
Community-based rehabilitation (CBR) is a strategy within community development for the
rehabilitation, equalization of opportunities and social integration of all people with disabilities.
CBR is implemented through the combined efforts of disabled people themselves, their families
and communities, and the appropriate health, education, vocational and social services.
This approach to CBR is multi-sectoral and includes all governmental and non-governmental services
that provide assistance to communities. Many of the services which can provide opportunities for and
assistance to people with disabilities are not traditionally considered relevant to CBR programmes
and people with disabilities. Examples include community development organizations, agricultural
extension services, and water and sanitation programmes.
In the ILO-UNESCO-WHO approach to CBR, the phrase "within community development" is
understood to be the following strategy recommended by the United Nations (3):
... the utilization, [in an integrated programme](4), of approaches and techniques which rely on
local communities as units of action and which attempt to combine outside assistance with
organized local self-determination and effort, and which correspondingly seek to stimulate local
initiative and leadership as the primary instrument of change.

In the CBR context, community means: (a) a group of people with common interests who interact with
each other on a regular basis; and/or (b) a geographical, social or government administrative unit.

PROGRAMME CRITERIA
The development and implementation of CBR programmes should be based on the following criteria:
1.

People with disabilities must be included in CBR programmes at all stages and levels,
including initial programme design and implementation. In order to give significance to
their involvement, they must have distinct decision-making roles.

2.

The primary objective of CBR programme activities is the improvement of the quality of
life of people with disabilities.

3.

One focus of CBR programme activities is working with the community to create positive
attitudes towards people with disabilities and to motivate community members to support
and participate in CBR activities.

4.

The other focus of CBR programmes is providing assistance for people with all types of
disabilities (physical, sensory, psychological and mental); for people of all ages, including
older people; for people affected by leprosy; for people affected by epilepsy; and for other
people who may be identified by the community as needing special assistance.

5.

All activities in CBR programmes must be sensitive to the situation of girls and women.
This is because in many communities throughout the Asian and Pacific region women are
not treated equally. When they are disabled, the problems that they face in life are
doubled. Furthermore, women are usually the primary family care-givers for all people
with disabilities.

6.

CBR programmes must be flexible so that they can operate at the local level and within
the context of local conditions. There should not be only one model of CBR because
different social and economic contexts and different needs of individual communities will
require different solutions. Flexible, local programmes will ensure community
involvement and result in a variety of programme models which are appropriate for
different places.

7.

CBR programmes must coordinate service delivery at the local level. Community
members seldom understand the different roles and specializations that are part of
providing assistance to people with disabilities. They tend only to see the problem of
disability and only to want access to "one window" for help. They may focus only on
where to go and who to see about a specific "problem", rather than understanding the
totality of what constitutes a fulfilling life for a community member who has a disability.

THE COMPONENTS OF COMMUNITY-BASED REHABILITATION PROGRAMMES

The components of a CBR programme should include:

1.

Creating a positive attitude towards people with disabilities: this component of CBR
programmes is essential to ensure equalization of opportunities for people with
disabilities within their own community. Positive attitudes among community members
can be created by involving them in the process of programme design and
implementation, and by transferring knowledge about disability issues to community
members.

2.

Provision of functional rehabilitation services: often people with disabilities require

assistance to overcome or minimize the effects of their functional limitations (disabilities).
In communities where professional services are not accessible or available, CBR workers
should be trained to provide primary rehabilitation therapy in the following areas of
rehabilitation:

3.

Medical

Eye care service

Hearing services

Physiotherapy

Occupational therapy

Orientation and mobility training

Speech therapy

Psychological counselling

Orthotics and prosthetics

Other devices

Provision of education and training opportunities: people with disabilities must have
equal access to educational opportunities and to training that will enable them to make
the best use of the opportunities that occur in their lives. In communities where
professional services are not accessible or available, CBR workers should be trained to
provide basic levels of service in the following areas:
o

Early childhood intervention and referral, especially to medical rehabilitation

services

4.

Education in regular schools

Non-formal education where regular schooling is not available

Special education in regular or special schools

Sign language training

Braille training

Training in daily living skills

Creation of micro and macro income-generation opportunities: people with disabilities

need access to micro and macro income-generation activities, including obtaining
financial credit through existing systems, wherever possible. In slums and rural areas,
income-generation activities should focus on locally appropriate vocational skills.
Training in these skills is best conducted by community members who, with minimal
assistance, can easily transfer their skills and knowledge to people with disabilities.

5.

Provision of care facilities: often, people with extensive disabilities are in need of
assistance. When they have no families or their families are incapable of caring for them,

in order for them to survive, long-term care facilities must be provided in the community
where they can get the assistance that they need. Moreover, day-care facilities may be
needed to provide respite for families who either work or need time off for other activities.
6.

Prevention of the causes of disabilities: many types of disability can be prevented by

relatively simple measures. Proper nutrition is one of the more significant ways of
preventing disabilities. Another important area of disability prevention is the detection of
disability in young children and intervention early in their development, to minimize the
effect of impairment. There are many other areas of disability prevention that are also
important. These include activities to decrease the number of accidents in the home, on
the road and at work, as well as other initiatives to encourage people to pursue healthy
lifestyles over the course of their lives.

7.

Management, monitoring and evaluation: the effectiveness and efficiency of all CBR
programme components, both in the community and in the area of service delivery
outside the community, depend on effective management practices. The impact of
programme activities must be measured on a regular basis. People must be trained in
effective management practices. Data must be collected, reviewed and evaluated to
ensure that programme objectives are met. In this way, the success or failure of a CBR
programme can be honestly measured.

SECTORS AND ROLES FOR THE DEVELOPMENT AND IMPLEMENTATION OF COMMUNITY-BASED

REHABILITATION
The initiative to start CBR programmes and to facilitate their development may come from any one of
the following groups. However, the effectiveness of CBR and the long-term development and
sustainability of any CBR initiative will require the coordination, involvement and collaboration of all
seven groups. The seven groups and their suggested roles are as follows:
1.

People with disabilities: People with disabilities can and should contribute to all levels of
CBR programmes in every position within a programme. They know what the effects of
local conditions are on themselves. They are likely to have a good understanding of those
effects on their peers with disabilities. They also know what impairment really means in
the context of their family, community and nation. This knowledge enables them to be
very effective members of a CBR team. They can be more effective than non-disabled
people as role models for and counsellors of other people with disabilities. People with
disabilities have an important role in community education. As community educators,
they serve as living examples of people with disabilities who make a significant
contribution, provided that they are given the opportunity and the right type of assistance.
CBR programmes should also facilitate the development of self-help organizations of
people with disabilities at the community level.

2.

Families of people with disabilities: families have the primary responsibility for caring for
all of their members. They are the first line of support and assistance for people with
disabilities at the local level. As such, families must be included in CBR programme
activities. Where the individual with a disability is not able, for whatever reason, to speak
for himself or herself, a family member should represent him or her and should be

considered a legitimate member of disabled people's organizations. Members of families

with experience in caring for people with disabilities are the people who most often
initiate CBR programmes and are, or prove to be, the most effective contributors at all
levels.
3.

Communities: community members should be involved in CBR programmes at all levels

because they already know the local environmental conditions, the local economy, the
local political situation and how to work with them. They also know about the
accessibility, availability and effectiveness of locally available rehabilitation services; who
in the community cares enough about other people to become a programme leader or
worker; and, which community members have the knowledge and skills for training
others in micro-economic activities. They are the people most likely to want to live, work
and stay in the community. Community involvement usually requires the agreement and
approval, both formal and informal, of the community leaders.

4.

Governments (local, regional, national): governments have the most important role in the
development and sustainability of CBR programmes. Their cooperation, support and
involvement are essential if CBR is to cover the total population and be sustainable. They
should implement and coordinate the development of the entire programme structure,
including the development of the referral system, as well as the activities within the
community. They also should provide resources for non-governmental organizations
(NGOs) and community activities. Finally, they should ensure that discriminatory
legislation is changed and that the rights of people with disabilities are guaranteed and
protected.

5.

Non-governmental organizations, local, regional, national and international

organizations: NGOs, including organizations of people with disabilities, are often able to
provide resources and skills to facilitate the development of new programmes, especially
in areas where none exist. They can develop new approaches to CBR and provide training
programmes for government employees, CBR workers, people with disabilities, families,
and community members. NGOs are effective in facilitating the development of
community members as CBR programme leaders. They are often best able to provide
long-term care facilities for those people with extensive disabilities whose families cannot
or will not look after them.

6.

Medical professionals, allied health science professionals, educators, social scientists

and other professionals: professionals are often in a position where they can, as trainers
and educators, facilitate the development of new programmes by making their knowledge
and skills accessible to community members and CBR programme workers. They can
also ensure that they support community efforts by making themselves available and
accessible on a referral basis. When they are in government service, they can advocate
and promote the development of CBR programmes as an effective way to provide locallevel services quickly.

7.

The private sector (business and industry): the private sector has a social obligation to
return some of the benefits of its operations to the communities that support it. In the
past, this support has largely taken the form of charity. Charity occurs when donors
"give" whatever they feel is needed or appropriate to people with disabilities. This

approach to assisting people with disabilities is no longer appropriate and needs to be

changed. Supporting CBR programme activities eliminates the need for charity. CBR
support is a much more appropriate way of directing resources to communities and
people with disabilities. By supporting CBR programmes, the private sector receives
credit for its social involvement while being guaranteed that its support is put to effective
and efficient use. Who but trained, knowledgeable community members would know what
is most needed by the people of their own community?

SUMMARY

In recent years a multi-sectoral (or multi-disciplinary) concept of CBR has evolved. That concept
emphasizes working with and through the community to create positive attitudes towards people with
disabilities, to provide assistance to people with disabilities and to make the necessary changes to
the environment and service delivery systems.
In response to this conceptual change, CBR is now defined as a community development programme
that has seven different components:
(i) Creation of a positive attitude towards people with disabilities;
(ii) Provision of rehabilitation services;
(iii) Provision of education and training opportunities;
(iv) Creation of micro and macro income-generation opportunities;
(v) Provision of care facilities;
(vi) Prevention of the causes of disabilities;
(vii) Monitoring and evaluation.
The resources, skills and initiatives to start and sustain CBR programmes require the cooperation and
collaboration of seven relevant sectors:
(i) People with disabilities
(ii) Families of people with disabilities;
(iii) Communities;
(iv) Governments (local, regional, national, international);
(v) NGOs, local, regional, national and international organizations, and organizations of people
with disabilities;
(vi) Medical professionals, allied health science professionals, educators, social scientists and
other professionals;

(vii) The private sector (business and industry).

foot notes
*

Prepared by the Working Group on CBR of the Regional Inter-agency Committee for Asia and the

Pacific (RICAP) Subcommittee on Disability-related Concerns. ESCAP serves as the secretariat of the
Subcommittee. All members of the Subcommittee contributed to the preparation of the document. The
Subcommittee, at its fourteenth session in May 1997, finalized and adopted the document to mark the
mid-point (1997) of the Asian and Pacific Decade of Disabled Persons, 1993-2002.
1. The Alma Ata Declaration of Health for All and its emphasis on primary health care included
services for people with disabilities. It is this concept that led to the development of the first models
of CBR which emphasized delivery of primary rehabilitation therapy in the community.
2.Community-Based Rehabilitation for and with People with Disabilities, 1994 Joint Position Paper,
International Labour Organization (ILO), United Nations Educational, Scientific and Cultural
Organization (UNESCO) and World Health Organization (WHO).
3. See document E/CN 5/291.
4. The original definition has been changed from "under one programme" to "in an integrated
programme".

Economics and Social Commission for Asia and the Pacific

Understanding community-based rehabilitation
UNITED NATIONS
New York, 1998
ST/ESCAP/1761
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Program Pemulihan Dalam Komuniti (PDK)

Pengenalan
Program Pemulihan Dalam Komuniti (PDK) atau "Community-Based Rehabilitation" (CBR) telah
dipelopori oleh Pertubuhan Kesihatan Sedunia (WHO).
Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam penyedian manual dan seterusnya
diberi peluang menilai dan mengubahsuai pelaksanaan program ini.
Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif dengan kerjasama Kementerian
Kesihatan Malaysia untuk menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu untuk
melibatkan 55 orang kurang upaya (OKU).
Program PDK ini berkembang dengan pesatnya serta mendapat sambutan yang begitu menggalakkan
dari masyarakat dari masa ke semasa.

Objektif
1.

Menggalakkan sikap prihatin, berdikari dan rasa tanggungjawab masyarakat tempatan dalam
program pemulihan orang kurang upaya (OKU).

2.

Mengembleng sumber tempatan untuk pemulihan sumber tempatan untuk pemulihan OKU.

3.

Menggalakkan penggunaan cara yang mudah dan teknik yang diterima, murah, efektif dan sesuai
dengan keaadaan setempat.

4.

Menggunakan infrastruktur organisasi tempatan yang sedia ada untuk memberi perkhidmatan.

5.

Mengambil kira sumber ekonomi negara dan membolehkannya untuk diperluaskan perkhidmatan
yang menyeluruh mengikut keperluan OKU

Program PDK Berteraskan Kepada 3 Model

Home Based.

Centre Based.

Centre-Home Based.

Aktiviti PDK

Kemahiran motor kasar.

Kemahiran motor halus.

Perkembangan sosial.

Perkembangan bahasa.

Pengurusan diri sendiri.

Pra-menulis, membaca, mengira dan melukis.

Kreativiti - permainan, rekreasi dan lain-lain.

Latihan Vokasional.

Terapi muzik.

Sukan dan rekreasi.

Konsep PDK 'One Stop Centre'

PDK "One Stop Centre'' sebagai "Focal Point'' kerana ianya satu program yang menggunakan pendekatan
integrasi komuniti di setiap daerah dan negeri.
Melalui PDK "One Stop Centre'', perkhidmatan kepada OKU akan disediakan di satu tempat bagi
memudahkan mereka dan masyarakat setempat mendapatkan maklumat, khidmat nasihat dan keperluan
semasa serta latihan yang bersesuaian.
Peranan PDK "One Stop Centre":

Pusat Intervensi Awal OKU.

Pusat Sumber maklumat OKU.

usat Rujukan OKU.

Pusat Pendaftaran OKU.

Pusat Advokasi.

PDKNet
PDKNet merupakan pelaksanaan program IT dan Multimedia bagi membantu golongan kurang upaya
seperti kanak-kanak Sindrom Down dan kanak-kanak yang menghadapi masalah pembelajaran.
Secara umumnya program ini berfungsi sebagai landasan untuk memperkembangkan dan membantu
dalam pemulihan golongan kurang upaya. Selain daripada itu, program PDKnet ini juga diharap dapat
menambah pengetahuan dan kemahiran orang kurang upaya untuk mengendalikan program perisian
komputer.

Program ini juga secara tidak langsung dapat memberi peluang kepada keluarga dan masyarakat
mengambil bahagian untuk berkomunikasi dan seterusnya membantu dalam proses pemulihan golongan
ini.
Untuk capaian PDKNet, ianya boleh dilayari melalui laman web www.pdknet.com.my

Pemulihan Dalam Komuniti

PROGRAM PEMULIHAN DALAM KOMUNITI (PDK)
Syarat Kemasukan:
Had Umur - Tiada had umur
i
Jenis OKU - semua jenis OKU yang mampu dilatih
ii
Ciri-ciri PDK :
Proses pemulihan dilakukan dalam komuniti tempatan
i
Ibubapa/ahli keluarga/komuniti memainkan peranan penting
ii

ii Menggunakan teknologi dan kos yang rendah

i
i Kaedah pemulihan dijalankan di PDK dan di rumah
v
Menggunakan sumber-sumber dan komuniti yang ada
v
Konsep PDK
Mendekatkan perkhidmatan pemulihan dan intervensi awal untuk OKU diperingkat
komuniti tempatan.
i
Memastikan penyertaan penuh dan integrasi sosial OKU dalam keluarga dan
komuniti.
ii
Mengurangkan penempatan jangka panjang di Institusi Pemulihan yang
ii menyebabkan OKU disisihkan dari keluarga dan komuniti.
i
Menyediakan platfom sesuai untuk OKU membangunkan kebolehan dan kemahiran
i mengikut potensi yang ada dalam diri.
v
Membantu dalam mewujudkan masyarakat penyayang yang prihatin kepada
keperluan OKU.
v

Peranan PDK masa kini:

Alternatif kepada pendidikan khas selaras dengan keperluan pendidikan wajib sekolah renda

di bawah Seksyen 3(2) Peraturan-Peraturan Pendidikan (Pendidikan Khas)1997 khusus untuk

mempunyai ketidakupayaan moderate dan severe (teruk).

Program Pendidikan Khas hanya menawarkan tempat kepada Kanak-Kanak OKU yang berupa

Kanak-kanak OKU yang telah menunjukkan peningkatan dalam pengurusan diri akan di perti
tempatkan di Sekolah Pendidikan Khas Kementerian Pelajaran.
Aktiviti di PDK
Kemahiran Motor Kasar
i
Kemahiran Motor Halus
ii
Perkembangan Bahasa
iii
Perkembangan Sosial
iv
Pengurusan Diri
v
Pra Menulis, Membaca, Mengira dan Melukis
vi
Kreativiti dan Retorik
vii
viiKemahiran Vokasional
i
Sukan Special Olympics
ix
Bakat Istimewa PDK
x

Pencapaian:
Faedah bagi keluarga dan masyarakat:

1. Insiden kecacatan dapat di kurangkan atau kecacatan lebih teruk dapat dicegah melalui in

sokongan keluarga yang dilatih.

2. Meningkatkan kesedaran di kalangan ahli keluarga akan potensi anak mereka untuk diban
dan bimbingan.

3. Meningkatkan keyakinan komuniti terhadap keupayaan yang ada dan menjadikan masyara
penyayang

Tuesday, February 15, 2011

penubuhan pdk ....

FAKTA BENAR TENTANG BILANGAN PUSAT PEMULIHAN DALAM KOMUNITI
YANG ADA DI MALAYSIA.
Pusat Pemulihan Dalam Komuniti atau nama singkatannya PDK kini telah
menjangkau ke 297 PDK se Malaysia dengan bilangan pelatih yang
menerima latihan pemulihan seramai 757 orang .
Bagaimana pdk mula bertapak daripada sebuah PDK hingga menjadi 379
buah PDK di seluruh Malaysia yang memberi manfaat kepada 9,514 orang
kurang upaya di seluruh Negara. Persoalan yang sentiasa bermain dalam
minda.
PENUBUHAN PDK
Kisahnya bermula apabila Program Pemulihan Dalam Komuniti (PDK) atau
"Community -Based Rehabilitation" (CBR) telah dipelopori oleh Pertubuhan
Kesihatan Sedunia (WHO). Jabatan Kebajikan Masyarakat telah terlibat
secara langsung dalam penyediaan manual dan seterusnya diberi peluang
menilai dan mengubahsuai pelaksanaan program ini.
Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif
dengan kerjasama Kementerian Kesihatan Malaysia untuk menjalankan
Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu yang
melibatkan 55 orang kurang upaya (OKU). Program PDK ini berkembang
dengan pesatnya serta mendapat sambutan yang begitu mengalakkan
daripada masyarakat dari semasa ke semasa.
PDK Batu Rakit merupakan PDK yang pertama ditubuhkan di Malaysia pada
tahun 1984. Penubuhan ini adalah inisiatif daripada Jabatan Kebajikan
Masyarakat dengan kerjasama Kementerian Kesihatan Malaysia yang ketika
itu menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala
Terengganu. Jumlah pelatih PDK sekarang adalah 43 orang yang
memulakan sesi pembelajaran seawal jam 8.00 pagi sehingga 1.00

tengahari, 5 hari seminggu.

Dalam memberi pemulihan kepada pelatih, PDK telah menetapkan

beberapa objektif:
Mengalakkan sikap prihatin, berdikari dan rasa tanggungjawab masyarakat
tempatan dalam program pemulihan OKU.Mengembleng sumber tempatan
untuk pemulihan OKU.Mengalakkan penggunaan cara yang mudah dan
teknik yang diterima, murah dan efektif dan sesuai dengan keadaan
setempat.Menggunakan infrastruktur organisasi tempatan yang sedia ada
untuk memberi perkhidmatan.Mengambil kira sumber ekonomi negara dan
membolehkannya untuk diperluaskan perkhidmatan yang menyeluruh
mengikut keperluan OKU. Antara aktiviti yang dijalankan oleh PDK ialah
memberi kemahiran motor kasar, Kemahiran motor halus, perkembangan
sosial, perkembangan bahasa, pengurusan diri sendiri, pra-menulis,
membaca, mengira dan melukis, kreativiti - permainan, rekreasi dan lainlain, latihan Vokasional, terapi muzik, sukan dan rekreasi.
PEMULIHAN DALAM KOMUNITI
Pemulihan Dalam Komuniti merupakan satu pendekatan baru yang
menekankan penglibatan lebih aktif Ibubapa, keluarga dan komuniti
tempatan terhadap usaha mencegah dan memulihkan Kanak- kanak Kurang
Upaya, khususnya di peringkat tempatan dalam konteks stuktur
perkhidmatan dan rancangan pembangunan yang sedia ada. PDK bertujuan
untuk memulihkan kanak- kanak Kurang Upaya supaya boleh berfungsi
seperti orang biasa, memberi kesedaran kepada komuniti/ masyarakat
setempat bahawa ada segolongan masyarakat yang tidak berkeupayaan
perlukan bantuan, memberi pengetahuan, kesedaran pemulihan kepada
Kanak- kanak Kurang Upaya, ahli keluarga dan saudara mara terdekat
dalam pemulihan dan membentuk
Jawatankuasa bertindak di kalangan ahli keluarga, golongan professional,
sukarelawan
dan komuniti tempatan dalam merancang program.
Program ini diuruskan oleh Jawatankuasa PDK yang dilantik melalui
persetujuan bersama antara Jabatan Kebajikan Masyarakat Malaysia dalam
komuniti setempat. Ianya dianggotai oleh ibubapa/penjaga ahli keluarga
golongan kurang upaya, pemimpin setempat, komuniti yang berminat dan
penasihat bagi Jawatankuasa PDK ialah Pegawai Kebajikan Masyarakat
Daerah dengan dibantu oleh Pegawai dari Kementerian Kesihatan dan
Kementerian Pendidikan (Pendidikan Khas).
Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam
penyediaan manual dan seterusnya diberi peluang menilai dan
mengubahsuai pelaksaan program ini.
Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif
dengan kerjasama Kementerian Kesihatan Malaysia untuk menjalankan

Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu yang

melibatkan 55 orang kurang upaya (OKU). Program PDK ini berkembang
dengan pesatnya serta mendapat sambutan yang begitu mengalakkan
daripada masyarakat dari semasa ke semasa.
Alamat pengasas pdk Batu Rakit
PDK Batu Rakit
9570 Kg. Mengabang,
Telipot Batu Rakit,
21020 Kuala Terengganu

DEFENISI PEMULIHAN DALAM KOMUNITI

Pemulihan Dalam Komuniti merupakan satu pendekatan baru yang

menekankan penglibatan lebih aktif Ibubapa, keluarga dan komuniti
tempatan terhadap usaha mencegah dan memulihkan Kanak- kanak Kurang
Upaya, khususnya di peringkat tempatan dalam konteks stuktur
perkhidmatan dan rancangan pembangunan yang sedia ada. PDK bertujuan
untuk memulihkan kanak- kanak Kurang Upaya supaya boleh berfungsi
seperti orang biasa, memberi kesedaran kepada komuniti/ masyarakat
setempat bahawa ada segolongan masyarakat yang tidak berkeupayaan
perlukan bantuan, memberi pengetahuan, kesedaran pemulihan kepada
Kanak- kanak Kurang Upaya, ahli keluarga dan saudara mara terdekat
dalam pemulihan dan membentuk Jawatankuasa bertindak di kalangan ahli
keluarga, golongan professional, sukarelawan dan komuniti tempatan
dalam merancang program.
Program ini diuruskan oleh Jawatankuasa PDK yang dilantik melalui
persetujuan bersama antara Jabatan Kebajikan Masyarakat Malaysia dalam
komuniti setempat. Ianya dianggotai oleh ibubapa/penjaga ahli keluarga
golongan kurang upaya, pemimpin setempat, komuniti yang berminat dan
penasihat bagi Jawatankuasa PDK ialah Pegawai Kebajikan Masyarakat
Daerah dengan dibantu oleh Pegawai dari Kementerian Kesihatan dan
Kementerian Pendidikan (Pendidikan Khas).
FAEDAH PENUBUHAN PDK
Terdapat banyak faedah dalam kewujudan pusat ini. Ia dapat membantu
golongan ibu bapa untuk mendapat pengetahuan secara lebih terperinci
cara mendidik anak anak istimewa ini. Dengan adanya pusat pemulihan
ini, ibu bapa dapat berkongsi masalah yang dihadapi dengan ibu bapa yang
mempunyai anak seperti mereka. Selain itu, kanak-kanak istimewa ini juga
menapat pendidikan yang bersesuaian dengan keadaan mereka dan ini
dapat meminimunkan kecacatan yang dialami oleh kanak- kanak ini.
Apabila menyetai program ini, ia dapat meningkatkan kesedaran kepada
ibu bapa bahawa kanak-kanak juga mempunyai kebolehan dan
keistimewaan sekiranya di beri peluang untuk mendapat bimbingan dan

latihan secara sistematik dan ini akan meringankan ibubapa dari segi
jagaan dan latihan serta membantu kanak-kanak menguruskan diri dan
berkomunikasi dengan persekitaran. Dengan adanya latihan secara
berterusan dan sistematik, anggota badan kanak-kanak dapat berfungsi
setelah di buat pergerakan dan dapat berinteraksi dengan rakan-rakan
untuk mewujudkan pergaulan positif ini sekaligus dapat memupuk sikap
berdikari dalam diri kanak-kanak istimewa ini.

KONSEP PEMULIHAN DALAM KOMUNITI

PDK' One Stop Centre '' sebagai' Focal Point'' kerana ianya satu program
yang menggunakan pendekatan integrasi komuniti di setiap daerah dan
negeri dan Jabatan Kebajikan Masyarakat memberi komitmen dalam
pembangunan Orang Kurang Upaya (OKU) melalui beberapa tindakan iaitu
Konvensyen mengenai Hak Kanak- kanak, Proklamasi Penyertaan Penuh
dan Penyamaan peluang di Rantau Asia dan Pasifik, Biwako
MelenniumFrameworkFor Actoin dan PDK sebagai satu pendekatan altenatif
dalam pemulihan OKU
Melalui PDK' One Stop Centre'', perkhidmatan kepada OKU akan disediakan
di satu tempat bagi memudahkan mereka dan masyarakat setempat
mendapatkan maklumat, khidmat nasihat dan keperluan semasa serta
latihan yang bersesuaian. Antara peranan PDK ialah Pusat Intervensi Awal
OKU, Pusat Sumber maklumat OKU, Pusat Rujukan OKU,Pusat Pendaftaran
OKU. Dan Pusat Advokasi.
Salah satu kaedah pemulihan yang diterima pakai oleh WHO dan juga
Jabatan Kebajikan Masyarakat Malaysia ialah kaedah Pemulihan Dalam
Komuniti (PDK) berasaskan terjemahan asalnya Community Based
Rehabilitation System (CBR). Kaedah PDK ini telah dipelopori oleh tiga
pakar perubatan dan juga physiotherapist WHO yang terdiri daripada E.
Helandar, P. Mendis dan G. Nelson yang telah menghasilkan sebuah manual
yang pada peringkat drafnya setebal hampir 300 muka.
Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam
penyediaan manual tersebut ini apabila pada tahun 1983 Malaysia telah
diwakili oleh seorang Pegawai Kebajikan Masyarakat dan seorang Pegawai
Perubatan untuk meneliti draf manual berkenaan dan seterusnya
memberikan peluang menilai dan mengubahsuaikan pelaksanaan kaedah
ini di suatu Mesyuarat Kumpulan Pakar (Expert Group Meeting) anjuran
WHO di Manila.
Hasilnya ialah Jabatan Kebajikan Masyarakat dengan kerjasama Jabatan
Kesihatan Negeri Terengganu khususnya, menjalankan satu projek perintis
PDK di Batu Rakit berasaskan hasil kajian ke atas profile orang kurang
upaya yang terdapat di Mukim Batu Rakit. Kajian itu dijalankan dengan
kerjasama semua peringkat penduduk dan Jabatan Kerajaan di mukim
tersebut dan melibatkan penduduk daripada sembilan (9) buah kampung
sejumlah 17,149 orang.Hasil kajian menunjukkan sejumlah 275 orang
kurang upaya dikenalpasti dan merupakan 1.65% daripada penduduk

mukim berkenaan.
Hasil daripada kajian tersebut telah meyakinkan Jabatan untuk dengan
ramainya melancarkan program PDK pada tahun 1984 oleh YB. Menteri
Kebajikan Masyarakat ketika itu. Pada peringkat awal pelancaran, Batu
Rakit telah dikenalpasti memandangkan mukim tersebut mempunyai
faktor-faktor yang sesuai untuk kajian dan juga disebabkan insiden kurang
upayaan yang ramai di Daerah Kuala Terengganu ketika itu. PDK ketika di
peringkat pelaksanaan awalnya hanya melibatkan seramai 55 orang.
Individu yang terlibat dalam program Pemulihan Dalam Komuniti (PDK) ini
boleh dibahagikan kepada beberapa kumpulan:
1. kumpulan pertama Jabatan Kebajikan Masyarakat JKM) yang terdiri
daripada pegawai-pegawai JKM bertugas sebagai
a. Penyelaras PDK peringkat negeri terdiri daripada pegawai JKM Bahagian
Pembangunan OKU dan kakitangannya
b. Penyelaras PDK peringkat daerah terdiri daripada pegawai JKM peringkat
daerah
2. kumpulan kedua pula hasil gabungan komuniti yang terdiri daripad
a. Pengerusi - terdiri daripada komuniti setempat / ibubapa pelatih/
pegawai gred A
b. Setiausaha - terdiri daripada komuniti setempat/ ibubapa pelatih /
pegawai gred A
c. Bendahari - terdiri daripada komuniti setempat/ ibubapa pelatih/ pegawai
gred A dsb
d. Ahli Jawatankuasa sekurang-kurangnya 8 orang terdiri daripada komuniti
setempat termasuklah ibubapa pelatih
3. kumpulan seterusnya daripada pegawai 2 daripada Jabatan Pendidikan
4. Pegawai daripada Jabatan Kesihatan
5. Pegawai daripada Jabatan Tenaga Kerja
6. BAKTI / kumpulan isteri wakil rakyat
7. Kumpulan Pengurusan PDK yang terdiri daripada penyelia PDK
8. Kumpulan terakhir dalam hierarki ini ialah petugas yang bertugas untuk
membuat pemulihan, pengajaran, pengasuhan dan penjagaan kepada
kanak-kanak OKU ini. Kumpulan ini yang paling hampir dengan kanak2 OKU
kerana mereka sama2 bermain, belajar, dan sebagainya.
Bagi setiap pdk , golongan yang terlibat adalah berbeza tapi ini hanyalah
yang paling asas sahaja

CBR: Community Based Rehabilitation

in Vellore

Introductio
n
Urban
Project
Partners
Toget
her
Vellore
CBR

Activities
CBR
Training

A project
looking at
Vellore
town: its
rehabilitatio
n needs
and how
they can be
met.

Further
Informa
tion
Contact Us

Introduction
Around 5% of the population of India are thought to have disabilities
that may benefit from rehabilitation services to improve their quality
of life. The World Health Organisation and United Nations
Development Programme have found that a Community Based
Rehabilitation (CBR) Programme is the best way to to this for a large
population. How that service should be modified in a community with
no organised Primary health care, or in an area with a well-developed
health care system has not been addressed.
This web page describes the CBR services provided by the PMR
department in Vellore that have tried to answer those questions. A
similar page was written as an academic report and so uses more
technical languageCBR: a technical report. Please read which ever you
like.

The Urban Project (Vellore CBR)

The common problems faced by people with disabilities are:

not knowing how rehabilitation can help them,

not having the money needed for rehabilitation services as they

are too expensive

rehabilitation services are provided in a place that is not easy to

get to and in a way that is difficult to use

there are not enough trained people in India to do the work.

The challenge is to find a way to deliver rehab services that works for
people with disabilities (PWD) in Vellore and then prove that it works.
Community based rehabilitation (CBR) services are one way to do
this.

Working together:
10 boys make a
pyramid and all are
visually impaired/blind

Dr Sara runs LCECU clinics

in the centre of town to
make them easier to get to.

Partners together
A different way of doing things in CBR has been suggested that educates
people so they know how to sort out their problem: an "educational model".
The educational model is different from traditional medical services.
Medical services are often seen as being the expert:non-expert model. The
healthcare professional such as the doctor is the "expert" about the disease
which the patient has. The "non-expert" is the patient who is told what to do
by the "expert" doctor. Understandably many people disagree with this
model for many reasons!
The educational model says that the healthcare professionals have
information about the disease and how it can be treated. The patient has
information and knows how the disease stops them doing things. Lets put
the two together as that way we should come up with a good answer. So
the healthcare professionals will pass on what they know, so educating the
patients. Together they can find the best way to sort our the patients
problems.
People with disabilities face many challenges. They often cannot do things
due to their disability eg cannot walk. CBR can help people find new ways
to do things. The disability has many other effects on their lives. As they
cannot walk it is difficult for them to get out of the house. So they cannot
get into the community to meet people, shop, go to school or work or be
part of any family or community activities. CBR can help people do all these
things with their families and communities. People with disabilities are also
often "discriminated" against. Many people think they cannot do things that
they can do. Many people also looks down on them and will not allow them
to do things. CBR looks to find ways to remove this discrimination.Thus
CBR is a way within community development for the
rehabilitation, equalisation of opportunities and social integration
of all people with disabilities.
In Vellore we feel that:

The rehabilitation services should be more than those found in

traditional institution-based services. Institutions tend to provide medical
rehabilitation eg provide artificial limbs and mobility aids and teach people
how to use them. We would like to give services like "education, vocational
training and income generation".

The link between rehabilitation services and the culture in which they
are is important - what is good in India may not work in the UK.

The need to change the way people think about others with
disabilities during the training of CBR workers is important.
Overall we felt that a community based rehabilitation project was the best
way to do this for people with disabilities in India. Starting such a project
should look at the culture of the people, involve the community and should
fit in with other services that already in Vellore for PWD.
The department of Physical Medicine and Rehabilitation (PMR) and the
Low Cost Effective Care Unit (LCECU) of Christian Medical College,
Vellore, South India have been jointly running a CBR programme in the
urban slums of Vellore since 2002. The slum population of Vellore town is
67,174. This project has been covering a population of approximately
23,000.

Vellore CBR
This project was set up to show that Community Based Rehabilitation can
help people with disabilities in Vellore town through the right assessment,
treatment and training. The approach used in the CBR project is an
education model which has been found to work in other developing
countries. The project uses the WHO training manuals and stresses that
people with disabilities need to be able to do things and know about things.
People without disabilities must have good attitudes to pwd.
The Local Supervisors (volunteers who live in the community) go to
classes. They are given the skills they need, including problem solving and
how to make use of things they can find near by, plus knowledge on how
various disabilities can be treated. They then find people with disabilities in
their local area and help them to identify their "felt needs". "Felt needs" are
what the PWD wants help with. These needs are then looked at by the
Local Supervisors (LS) and PWD working in partnership together to find an
answer. The LS act as local rehabilitation resource persons through this
education model. The CBR find out what can be bought nearby and what
services, colleges and schools there are and set up ways to refer people on
to otheres if needed. This should improve the quality of life of PWD.
A more detailed break down of the project is given below.

Aim:
To show that people with disabilities (PWD's) can be helped by suitable
assessment, treatment and training in a Community Based Rehabilitation
Programme.

Objectives:
(a) Service Delivery

Surveying Vellore
town slums

1.

To assess

what people with disabilities can do as they are found by the

Local rehabilitation workers

what people with disabilities and their Community think they

need from Rehabilitation services

2.

To demonstrate that this kind of CBR

3.
o
o
o
4.
5.

Can help people to dress, get around, bath more easily etc.
Can improve the physical health and quality of life of disabled
persons and their families.
Can keep complications as small as possible.
To enable people with disabilities to learn how to become problem
solvers and so to overcome their problems.
To show that disabled children can be educated in their community.
(b) Economic/Money Help

5.
6.

To help disabled adults to see what jobs they could do.

To train them in technical skills and work, as near to their homes as
possible.

7.

To train and encourage them in business skills like looking after their
money.

8.
9.

To help people with disabilities settle in their jobs.

To enable PWD's to become "resource earners rather than being
merely resource burners".
(c) Training

Training for the rehab

workers using
fun and games!

10.
11.

To teach the local supervisors how to solve problems.

To train the local supervisors to use what is available. These

resources will include people such as their fellow local supervisors and
teachers, plus books like those used on the course.
(d) Research

12.
To study what happens as we set up this pilot CBR project and then
use this information to modify the larger project that will follow.
13.
To follow up people with disabilities at home, in schools and at work to study the good and the bad, and to learn from them.
14.
To look at the effect of CBR on the health, social well being and the
quality of life of PWD's.
15.
To look at the good and bad bits, easy and hard, cheap and
expensive areas of our rehabilitation services. The services include CBR,
general rehab and highly specialist rehab services.
The World Health Organisation funded this Community based rehabilitation
project for two years. The work started in 2002 and has continued with

various sources of funding. A document on Vellore CBR has been

published in the WHO India website.
http://whoindia.org/EN/Section20/Section23/Section308.htm

Vellore CBR activities

Awareness Sessions:

Samuel Nagar children

singing a song
on road safety

PEER to PEER Education:

Accident prevention:

Children from one of the slum communities (Samuel Nagar) visited a local
school (Ida Scudder School) on their Founder?s day. Encouraged by the
LS and the team they sung songs, danced and did drama about
"prevention of disability through accident prevention".
The school enjoyed their visit and were very impressed.
The CBR team took part in an Exhibition at LCECU on 9th and 10th
December 2004. The pictures and posters looked at problems with General
health eg heart problems, life style eg how smoking is bad for you, and
what PWD can do.

LCECU Exhibition
Local school children
take part
at the LCECU

Experiencing disability
by NCC students

Interaction with
community volunteers

Role play on role

of volunteers

Presenting a plan of action

following a group discussion

Health status monitoring

by the hospital staff

Camp participants
enjoying a game

Exhibiting talents

Role play by LS
at Filterbed Medu
network meeting

-Look at our strengthAnna Nagar &

Samuel Nagar group

LIFESTYLE & HEALTH:

Spinal cord injury prevention and management:

Spinal cord injury causes people to be paralysed in the legs and/or arms,
they also cannot feel anything. This can last a life time.
A workshop on "Prevention and management of Spinal Injury" was
organised at Voorhees College for members of the National Cadet Corps
(NCC) students from local colleges on 11.2.2005. A team planned and
organised this programme. The team was from the Rehabilitation Institute
and Low Cost Effective Care Unit (LCECU) of CMC including a person with
spinal cord injury Mr. Manoharan .
Blood Donation;

An awareness session on "Blood donation" was given at Samuel Nagar for

the community volunteers by the CMC Blood bank staff. Following this
meeting a group of youth have come forward to give blood as and when
required.
Integrated education:

A session on the "Role of Teachers" in having disabled children in the

normal school was conducted by Mr. Guru Nagarajan for 60 secondary
school teachers at Kaniyambadi.
Volunteering:

A presentation was done at Ida Scudder School. It was on the "role of

volunteers" - what can be done as volunteers for PWD in the community.
The aim was to encourage volunteering among school teachers and
students.
A meeting held for volunteers from the community who were in a
networking programme to plan to start a forum/meeting called "friends of
PWD"

SHARING OF RESOURCES
Review of a health manual

The CBR team of CMC was asked by the Hesperian Foundation to look at
the draft of the "health manual for women with disabilities" before it was
published. This was done with Mrs. Usha Jesudassan, a freelance
journalist, the local supervisors from the CBR project, women with
disabilities from the community and the CBR team members over two days.
Focus group discussion on problems of elderly

Dr. Sara Bhattacharji & Mr. Guru Nagarajan helped a Focus group to
discuss the problems of the elderly in 2005. The group were students from
Indra Gandhi National Open University.
Training for Tibetan settlements:

Mr. Guru Nagarajan helped on two training sessions on "Initiation of CBR in

Tibetan Community" at Bylakuppe and Mundgod (Tibetan settlements in
Karnataka) by the department of Health, Central Tibetan administration.
Ms. Heather Payne from the Christian Medical Association of India (CMAI)
and Ms. Kirpa Verghese, CMC graduate also helped.

CAMPS
General health screening camp:

At the request of the community members through one of the Local

Supervisors (LS) (cbr worker), a general health screening camp was held in
Kagithapattarai. 168 peoples attended the camp. The LS's help in getting
everything organised was much appreciated.
A special camp for elderly people

A camp just for the elderly people living in Anna Nagar, Samuel Nagar was
held. 43 old people took part in games, focus group discussions and
medical screening.

NET WORKING
CBR Thiruvizha

A one-day festival for networking PWD in Vellore Town was held at a local
school by the LS. 111 persons including 74 PWD actively participated
despite heavy rain. Several programmes including indoor games,

awareness sessions, a talent show and group sessions were conducted. It

is encouraging to note that a number of community volunteers helped to
organise the programme. This festival was the first step to shift from
individual focussed intervention to group work.

Blind leading the blind:

Mr. Murugan donated
a walking stick to
Mr. Pattabi.

Networking meetings:

Following CBR thiruvizha 3 LS have started group meetings of the PWD in

their area. The PWD have begun to identify the needs and problems
among themselves and are starting to solve these problems using the time,
expertise and financial resources found within the group. They have also
made use of government and other public or private resources available.
The team felt that a series of training sessions on "capacity building" will be
useful for improving the organisation of these groups.
The team hope to learn the dynamics of rehabilitation needs in the urban
community through this project. This project was also designed to be a pilot
project for the larger rural project. The full urban project will provide a CBR
programme to other areas where there are needs. The department and
charitable donations fund the continuation of the project. The experience
gained from starting this project has helped to offer training on CBR for
WHO fellows and guidance and training for Tibetan settlements at
Karnataka State. Training on CBR may be organised if asked fo

Community Based Rehabilitation Training

for Managers, Co-ordinators and Facilitators
The Department of Physical Medicine & Rehabilitation offers a training
programme in CBR which is

Field based

Comprehensive

Participatory

Integrated

Experiential

Who we are?

CMC is known for its outstanding and comprehensive health care with
a focus on those who are marginalised, as well as for its excellent value
based education in health sciences. CMC Home page

The Departments of PMR and LCECU offer this training jointly. This
training is offered in the context of an existing CBR programme in the
poorer areas of Vellore Town. Description of project on WHO website

Resource persons for the course will be disabled persons, volunteers

from the community, senior medical faculty of CMC from various disciplines
like PMR, Psychiatry, ENT, Ophthalmology, Community Health & General
Practice; Allied Health Professionals like Physio therapists, Occupational
Therapists & Social Workers.

Medium:
Training will be in English.

Who can join?

The course is open to professionals in the health / rehabilitation field. This
training is open to doctors, nurses, allied health professionals, social
scientists, those in GO/NGO sector with an interest in CBR. A minimum of 4
trainees should be available for training.

Outcome
At the end of this training programme the participants would be able to

describe the components of a participatory community based

rehabilitation programme.

list the roles of primary, secondary and tertiary centres.

understand the concept of a referral system from community to the

secondary and tertiary care centres and back to the community

list some socio-economic interventions that can be carried out in the

community

initiate, carry out and evaluate CBR programme within a particular

context.

link quality of life of disabled persons and CBR.

Further Information:
Contact for further details regarding CBR training:
S. Guru Nagarajan
Social Worker,
Rehabilitation Institute,
Christian Medical College,
Vellore. 632 002, Tamil Nadu
Phone: 0416-2284554
Email: guru@cmcvellore.ac.in