CBR in Afghanistan

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CBR in Afghanistan

• Jenny Wickford
• PhD RPT

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CBR in Afghanistan
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CBR in Afghanistan

• Different NGOs have been running CBR since early
  1990s, by various different NGOs

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CBR in Afghanistan

• Different NGOs have been running CBR since early
  1990s, by various different NGOs
• CBR is implemented in 16 / 34 provinces

5
CBR in Afghanistan

• Different NGOs have been running CBR since early
  1990s, by various different NGOs
• CBR is implemented in 16 / 34 provinces
• Often include service provision (eg physiotherapy
  and assistive devices) since the government has
  not been able to do this

6
CBR in Afghanistan

• Different NGOs have been running CBR since early
  1990s, by various different NGOs
• CBR is implemented in 16 / 34 provinces
• Often include service provision (eg physiotherapy
  and assistive devices) since the government has
  not been able to do this
• Undergoing change unsure about what will happen
  in future

7
CBR in Afghanistan

• Different NGOs have been running CBR since early
  1990s, by various different NGOs
• CBR is implemented in 16 / 34 provinces
• Often include service provision (eg physiotherapy
  and assistive devices) since the government has
  not been able to do this
• Undergoing change unsure about what will happen
  in future
• Rehabilitation of Afghans with Disabilities (RAD)
  largest disability programme in the country

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Rehabilitation of Afghans with Disabilities

• Geographical spread

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Rehabilitation of Afghans with Disabilities
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Rehabilitation of Afghans with Disabilities

• 5 different components
• Special and inclusive education
• Information, education, communication
• Vocational training and revolving loans
• Physiotherapy
• Orthopaedic workshops

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Physiotherapy component
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Physiotherapy component

• Institution-based services

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Physiotherapy component

• Institution-based services
• Home-Based Training

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Physiotherapy component

• Institution-based services
• Home-Based Training
• Community-based physiotherapy?

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Community-based health services?

• Goal of CBR in relation to health that people
  with disabilities achieve their highest
  attainable standard of health (WHO, CBR
  Guidelines, Health Component, 2010).

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Community-based health services?

• Goal of CBR in relation to health that people
  with disabilities achieve their highest
  attainable standard of health (WHO, CBR
  Guidelines, Health Component, 2010).
• Thus, what is the role of a physiotherapist,
  occupational therapist or nurse in a CBR
  programme? An orthopaedic technician?

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Community-based health services?

• Goal of CBR in relation to health that people
  with disabilities achieve their highest
  attainable standard of health (WHO, CBR
  Guidelines, Health Component, 2010).
• Thus, what is the role of a physiotherapist,
  occupational therapist or nurse in a CBR
  programme? An orthopaedic technician?
• DISCUSSION

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Community-based health services?

• Role of CBR in relation to health to work
  closely with the health sector to ensure that the
  needs of people with disabilities and their
  family members are addressed in the areas of
  health promotion, prevention, medical care,
  rehabilitation and assistive devices. CBR also
  needs to work with individuals and their families
  to facilitate their access to health services and
  to work with other sectors to ensure that all
  aspects of health are addressed (WHO, CBR
  Guidelines, Health Component, 2010).

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Community-based health services?

• Technical expertise as part of a referral system
  is essential for CBR programmes to function If
  following the basic assessment, CBR personnel
  identify a need for specialized rehabilitation
  services, e.g. physiotherapy, occupational
  therapy, audiology, speech therapy, they can
  facilitate access for people with disabilities by
  initiating referrals (WHO, CBR Guidelines, 2010)

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Community-based health services?

• Technical expertise as part of a referral system
  is essential for CBR programmes to function If
  following the basic assessment, CBR personnel
  identify a need for specialized rehabilitation
  services, e.g. physiotherapy, occupational
  therapy, audiology, speech therapy, they can
  facilitate access for people with disabilities by
  initiating referrals (WHO, CBR Guidelines, 2010)
• For eg, physiotherapists with a particular
  community focus community or community-based
  physiotherapists
• Require additional skills
• Not just home-based treatment! Work with
  education, advocacy and awareness, lobbying,
  collaboration with other professionals etc

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Community-based health services?

• In Afghanistan, physiotherapy and orthopaedic
  technicians were included by necessity, since
  these services are not sufficiently available
  within the national health-care structures.

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Community-based health services?

• In Afghanistan, physiotherapy and orthopaedic
  technicians were included by necessity, since
  these services are not sufficiently available
  within the national health-care structures.
• Present challenge to shift physiotherapy in
  national healthcare structures
• Salary issues
• Technical support challenges
• Status
• Less recognition of the profession within
  national healthcare structure

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Community-based health services

• Present developments 2011
• Expanding the training, to specifically train
  physiotherapists for the national healthcare
  structure
• Adapting the present 3-year curriculum to
  strengthen referral system and collaboration
  between relevant health professionals, to
  strengthen links with communities, and to raise
  awareness of rehabilitation services

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Community-based health services

• Present developments 2011
• Expanding the training, to specifically train
  physiotherapists for the national healthcare
  structure
• Adapting the present 3-year curriculum to
  strengthen referral system and collaboration
  between relevant health professionals, to
  strengthen links with communities, and to raise
  awareness of rehabilitation services
• Future possibilities
• Institution-based physiotherapists community
  physiotherapists

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Community-based health services

• Present developments 2011
• Expanding the training, to specifically train
  physiotherapists for the national healthcare
  structure
• Adapting the present 3-year curriculum to
  strengthen referral system and collaboration
  between relevant health professionals, to
  strengthen links with communities, and to raise
  awareness of rehabilitation services
• Future possibilities
• Institution-based physiotherapists community
  physiotherapists
• Huge challenge to move away form dependency on
  NGOs as services are moved into government
  structures

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