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THE ORIGINS OF COMMUNITYBASED REHABILITATION.

By Einar Helander MD, PhD

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Contents
1. Introduction
2. WHO policies in 1974
3. Estimation of the prevalence of disability
4. The 1974 WHO Policy document
5. WHO’s new Programme for disability prevention
6. WHO’s new Programme for community-based rehabilitation
Situation analysis.
Field studies
Community mobilization
Sustainability
Conclusions
7. Rehabilitation as a component of primary health care
8. Formulating and testing the technology
9. WHO adopts the new policy
10. Developing managerial tools
11.Financing CBR
12.Dealing with the resistance
13.CBR in the developed countries
14.Childhood violence and maltreatment
15.Media
16.The future of CBR
Refer ences

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This documents has been written at the r equest of the Disability and Rehabilitation Programme at the World Health Organization, Hea dquarters, Geneva, Switzer land

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THE ORIGINS OF COMMUNITY-BASED
REHABILITATION.
1. Introduction.
In 1973 Dr. Halfdan Mahler was elected Dir ector-General of the World Healt h Organization. During 15 years he initiated a large number of new policies a nd programmes – a clear break with those that had governed WHO during his predecessors. Dr Mahler was deeply concerned a bout “the existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries; this was seen as politically, socially and economically unacceptable”1. Ther e wa s also a reaction against the health sector concentration on high-level hospital care, which at that time consumed some 90% of the health budgets in most developing countries. The reality in the developing countries was that most populations, especially the rural poor ha d little or no access to a ny hea lth care. As an exa mple, when the author visited Cote d’Ivoir e a few years later ther e wer e three University hospitals in its capital Abidjan, each of them ha d more doctors than the entir e population of some 10 million living outside the capital. The results of the lack of health care were devastating: high infant and child mortality rates, malnutrition, rampant epidemic diseases, chronic diseases, disability and low productivity. The indirect economic consequences wer e of great concer n: wor kers produce mor e when they are healthy. The new WHO policy “Health For All” was to inspire all countries to deliver at least the essential services to all, making health accessible and affordable, while using appropriate technology.

The author was recruited to the WHO Headquarters in August 1974 as their first specialist in r ehabilitation, my predecessors had come from the public hea lth sector, and r ehabilitation had for them been a part-time job. I was assigned to the Division of Strengthening of Health S ervices; a Division that had just started to develop the new health strategies. At my arrival, I was given five months to produce a new disability /rehabilitation policy for WHO2.

2. WHO policies in 1974.
The WHO policies that existed at my arrival had been guided by a group of eminent specialists, who had issued two Technical Reports, one in 1958 and the second and latest was from 19693. These r eports contain policy r ecommendations and state-of-the-art technology descriptions and are distributed to all Ministries of Hea lth of all its Member States and appear in the widely distributed catalogue of official WHO publications. The citations that follow r eflect the official view of the Organization.

The 1969 report states that “…rehabilitation is complex, involving several disciplines a nd differ ent techniques working together a s a tea m in or der to achieve the best end r esults for the ha ndicapped persons.” It recommended that rehabilitation should “establish schools for allied health and rehabilitation personnel…to promote r ehabilitation faculties of medicine should...
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