Primary health care and community-based rehabilitation in the People's Republic of China

This paper provides the background to the introduction of community-based rehabilitation (CBR) into a rural area of Guandong Province in the People's Republic of China (PRC). CBR, in this pilot project, is implemented using the existing primary health-care network. Two examples, one from a township and the other from a rural village, are presented. It is concluded that, given the estimated 51840000 disabled persons in the PRC, CBR is the ideal means whereby 'rehabilitation for all' can be achieved in China.     

Primary health care and community-based rehabilitation in the People's Republic of China

This paper provides the background to the introduction of community-based rehabilitation (CBR) into a rural area of Guandong Province in the People's Republic of China (PRC). CBR, in this pilot project, is implemented using the existing primary health-care network. Two examples, one from a township and the other from a rural village, are presented. It is concluded that, given the estimated 51840000 disabled persons in the PRC, CBR is the ideal means whereby 'rehabilitation for all' can be achieved in China.     

Community-based rehabilitation in the People's Republic of China

This paper describes the implementation of a pilot community-based rehabilitation (CBR) programme in a densely populated urban centre of Guangzhou (Canton) City. The structure of the programme utilizing the existing administrative and government structures of the province (Guandong), the city and the urban centre (Jin Hua Street) and administration of the project are described. Finally, the paper addresses some issues related to research on CBR in the People's Republic of China (PRC).     

Community-based rehabilitation in the People's Republic of China

This paper describes the implementation of a pilot community-based rehabilitation (CBR) programme in a densely populated urban centre of Guangzhou (Canton) City. The structure of the programme utilizing the existing administrative and government structures of the province (Guandong), the city and the urban centre (Jin Hua Street) and administration of the project are described. Finally, the paper addresses some issues related to research on CBR in the People's Republic of China (PRC).     

Community-based rehabilitation in the People's Republic of China

This paper describes the implementation of a pilot community-based rehabilitation (CBR) programme in a densely populated urban centre of Guangzhou (Canton) City. The structure of the programme utilizing the existing administrative and government structures of the province (Guandong), the city and the urban centre (Jin Hua Street) and administration of the project are described. Finally, the paper addresses some issues related to research on CBR in the People's Republic of China (PRC).     

Community-based rehabilitation programme as a model for task-shifting

This article explores some of the implications of a non-governmental organisation (NGO) initiated community-based rehabilitation (CBR) programme, for HIV-related task-shifting programmes which have been recommended by the World Health Organisation (WHO) as an important aspect of HIV prevention, treatment and care programmes. The CBR programme is run by multi-skilled community rehabilitation facilitators (CRFs) in a low income, rural context in KwaZulu-Natal, South Africa, and explicitly recognises the multiple facets of disability. As such, the programme focuses on both the physical and social aspects of living with disabilities. A qualitative approach was used to conduct this study, and semi-structured interviews were conducted with beneficiaries of the programme (n == 35), home and community-based care givers (HCBCs) (n == 13), and managers (n == 2). A focus group discussion was conducted with CRFs (n == 5). We found that the CBR programme successfully delivered rehabilitation services at a community level and that multi-skilled CRFs are an effective means of implementing CBR programmes in low-income rural areas. The developmental focus of the programme created a range of benefits for people with disabilities, including: physical rehabilitation, emotional support and counselling, access to grants, social inclusion and accessing assistive devices. Central to the programme's success was the maintenance of relationships and partnerships at different levels in the community, these included relationships between HCBCs and CRFs, between CRFs and therapists, and between the NGO and the various participants in the programme. However, the NGO struggled to maintain a partnership with the relevant government departments and this had important implications for the programmes sustainability. In conclusion, we argue that this programme's use of multi-skilled mid-level workers who have undergone effective training programmes in CBR demonstrates that a wide range of rehabilitation activities can be effectively undertaken at a community level, and that this programme provides an important example of how the WHO's task-shifting guidelines for HIV treatment, care and prevention can be implemented.     

Notes on the Landmark Development of CBR in China

Abstract Community-based rehabilitation has a history of 22 years in China. In spite of the preliminary achievement and experiences obtained by the pioneering and trial projects, it was not until the beginning of the new century that CBR in China experienced a landmark development. This is characterized by a number of favorable policy by the government for CBR; the mechanism facilitating primary health care with CBR, a new work-force system of CBR reorganized with better motivation and efficiency, 99 demonstration projects of CBR bringing about benchmark promotion effect and the active involvement in CBR by social resources agents. Key words community-based rehabilitation; rehabilitation; community     

A glimpse of community-based rehabilitation in China.

As in other developing countries, community-based rehabilitation (CBR) in China is very important. However, because of differences in the social system, economy, and cultural level, it is impossible to implement a uniform model of CBR. This paper introduces material to show how CBR in China tends to be spontaneous. Experience of CBR stations in Shenyang has initiated a new approach to CBR within the cultural characteristics of China.     

社区康复在残疾人康复体系中的意义及发展现状

社区康复作为社区发展计划的一项康复策略,具有覆盖面广、方便、经济、有效的特点,可有效提高社区残疾人的生存质量,在我国得到发展推广。目前在残疾人中开展社区康复也面临诸多问题,已不能满足社区残疾人多样化的康复需求,所以宣传社区康复理念、建立康复队伍、加强多部门合作,重视农村社区康复发展成为必然趋势。     

Notes on the Landmark Development of CBR in China

Community-based rehabilitation has a history of 22 years in China.In spite of the preliminary achievement and experiences obtained by the pioneering and trial projects,it was not until the beginning of the new century that CBR in China experienced a landmark development.This iS characterized by a number of favorable pohcy by the government for CBR;the mechanism facilitating primary health care with CBR,a new work-force system of CBR reorganized with better motivation and efficiency,99 demonstration projects of CBR bringing about benchmark promotion effect and the active involvement in CBR by social resources agents.     

Community-based rehabilitation programme as a model for task-shifting

This article explores some of the implications of a non-governmental organisation (NGO) initiated community-based rehabilitation (CBR) programme, for HIV-related task-shifting programmes which have been recommended by the World Health Organisation (WHO) as an important aspect of HIV prevention, treatment and care programmes. The CBR programme is run by multi-skilled community rehabilitation facilitators (CRFs) in a low income, rural context in KwaZulu-Natal, South Africa, and explicitly recognises the multiple facets of disability. As such, the programme focuses on both the physical and social aspects of living with disabilities. A qualitative approach was used to conduct this study, and semi-structured interviews were conducted with beneficiaries of the programme (n?=?35), home and community-based care givers (HCBCs) (n?=?13), and managers (n?=?2). A focus group discussion was conducted with CRFs (n?=?5). We found that the CBR programme successfully delivered rehabilitation services at a community level and that multi-skilled CRFs are an effective means of implementing CBR programmes in low-income rural areas. The developmental focus of the programme created a range of benefits for people with disabilities, including: physical rehabilitation, emotional support and counselling, access to grants, social inclusion and accessing assistive devices. Central to the programme's success was the maintenance of relationships and partnerships at different levels in the community, these included relationships between HCBCs and CRFs, between CRFs and therapists, and between the NGO and the various participants in the programme. However, the NGO struggled to maintain a partnership with the relevant government departments and this had important implications for the programmes sustainability. In conclusion, we argue that this programme's use of multi-skilled mid-level workers who have undergone effective training programmes in CBR demonstrates that a wide range of rehabilitation activities can be effectively undertaken at a community level, and that this programme provides an important example of how the WHO's task-shifting guidelines for HIV treatment, care and prevention can be implemented.     

Using participatory action research in community-based rehabilitation for people with acquired brain injury: from service provision to partnership with Aboriginal communities

Purpose.?Community-based rehabilitation (CBR) developed in response to delivery of rehabilitation services to people with disability in developing countries, and appears appropriate to address rehabilitation needs of rural and remote populations, including Australian Aboriginal People with acquired brain injury (ABI). This article will describe participatory action research (PAR) as a vehicle for exploring and translating the CBR model within a mainstream brain injury rehabilitation service in Queensland, Australia.

Method.?PAR was conducted with two self-selected remote Aboriginal communities in Far North Queensland. Key components to this project were the employment of a local Aboriginal worker, facilitating community engagement and consultation. PAR elements of planning, action and review were conducted through individual and group meetings and activities within the communities across a 3-year period.

Results.?The project has facilitated expansion and change within the current brain injury rehabilitation service model in line with CBR philosophical foundations, including community development and partnership as a desirable way of engaging with key stakeholders.

Conclusions.?The focus on community consultation through PAR and the development of community partnerships has increased the cultural competency of the rehabilitation service, the capacity of participating communities and of the sector to respond in ways that are valued and owned by Aboriginal People with brain injury, their families and communities.     

Some ethical issues in community-based rehabilitation initiatives in developing countries

Purpose : This commentary provides both theoretical and practical insights into the concept of community-based rehabilitation (CBR) and its application in developing countries. In doing so it explores current practices in CBR and the debate surrounding them, namely the ethical question and how this may impact on future CBR. The main argument in this account is that disability is a development issue; with widespread poverty, inequality and violation of human rights, and should be addressed within the broader context of community development which may include strategies such as CBR.

Method : A review and analysis of recent literature on CBR has been conducted including the review of a number of empirical research documents from various CBR initiatives in developing countries.

Results : CBR has increasingly been under scrutiny in terms of the extent to which these have succeeded in delivering rehabilitation services to those in need in the community as well as the permitted level of participation and control of disabled people over the rehabilitation process. Many programmes have been unsustainable and it has been difficult to evaluate their full usefulness to disabled people. These issues raise an ethical question about CBR being an appropriate strategy for the rehabilitation of people with impairments in developing countries.

Conclusion : This background emphasizes that new directions in CBR need to be put in place in order to maximize the realization of the ultimate goal: the greatest participation for disabled people in all spheres of life. Effective rehabilitation programmes should allow people with disability to have greater control in the nature of their rehabilitation and that the role of professionals and other stakeholders is one of allies and resources in the rehabilitation process. Moreover, the participation of community members in the rehabilitation policy should be assured.     

Some ethical issues in community-based rehabilitation initiatives in developing countries

Purpose : This commentary provides both theoretical and practical insights into the concept of community-based rehabilitation (CBR) and its application in developing countries. In doing so it explores current practices in CBR and the debate surrounding them, namely the ethical question and how this may impact on future CBR. The main argument in this account is that disability is a development issue; with widespread poverty, inequality and violation of human rights, and should be addressed within the broader context of community development which may include strategies such as CBR. Method : A review and analysis of recent literature on CBR has been conducted including the review of a number of empirical research documents from various CBR initiatives in developing countries. Results : CBR has increasingly been under scrutiny in terms of the extent to which these have succeeded in delivering rehabilitation services to those in need in the community as well as the permitted level of participation and control of disabled people over the rehabilitation process. Many programmes have been unsustainable and it has been difficult to evaluate their full usefulness to disabled people. These issues raise an ethical question about CBR being an appropriate strategy for the rehabilitation of people with impairments in developing countries. Conclusion : This background emphasizes that new directions in CBR need to be put in place in order to maximize the realization of the ultimate goal: the greatest participation for disabled people in all spheres of life. Effective rehabilitation programmes should allow people with disability to have greater control in the nature of their rehabilitation and that the role of professionals and other stakeholders is one of allies and resources in the rehabilitation process. Moreover, the participation of community members in the rehabilitation policy should be assured.     

社区康复管理和技术人员培训模式探讨

社区康复人才培养一直是社区康复工作重要一环,如何针对学员的背景、工作角色和职责及残疾人需求培养出懂知识、会操作、能服务的应用型人才,一直是社区康复培训组织者希望达到的目标。本文通过讨论中国残联/香港复康会合作项目中国社区康复合作项目中探索的一些方法,如逐级培训模式、参与式培训及实地探访等,为今后类似的培训提供一些借鉴和参考。     

Risk assessment and management for providers of community-based rehabilitation to people with acquired brain injury: Health professionals' perspectives

Purpose.?This study aimed to explore health professionals' perspectives regarding the presence, assessment and management of risks when providing community-based rehabilitation (CBR) to clients with acquired brain injury (ABI).

Method.?A qualitative approach using semi-structured interviews of health professionals working in CBR.

Results.?The main themes were: (1) risk assessment in CBR settings is an informal, unstructured, complex, multi-phase and cyclical process extending over a period of time; (2) structured and standardised risk assessments were not considered ideal for use in CBR services catering for people with ABI; (3) CBR services face numerous challenges in providing effective risk assessment and management; (4) the risks encountered by health professionals in CBR settings are not always predictable or preventable; and (5) CBR risk management focuses on implementing a range of practical strategies.

Conclusions.?A flexible risk assessment process supported by a range of practical risk management strategies to minimise and manage potential risks is advocated by health professionals working in CBR services for people with ABI. There is a need for more research into the effectiveness of current risk assessment and management strategies for CBR services.