Community-Based Rehabilitation

CBR as a strategy was first introduced by WHO and is mostly used by NGOs in Bangladesh. While ultimate responsibility for the health system lies with the government, most health care is provided by a combination of public, private traditional and informal sectors. At government level, the health sector has not strictly followed the WHO guidelines for CBR nor integrated it with the primary care system (Rahman, 2017). It is the Ministry of Social Welfare (MoSW) that has oversight over 103 physiotherapy centres, which are run by the JPUFs and provide free physical, occupational, and speech treatment, as well as hearing and vision exams, gadgets, and mobility aids. The World Bank provided support to 50 of these JPUF institutions. This distinction of having JPUF under the MoSW maintains that disability-inclusive support lies in the realm of welfare and charity, rather than public health.

CBR programmes provided by NGOs combine service delivery with community development and efforts to achieve equity for persons with disabilities. They are supported by a number of groups including the Centre for Rehabilitation of the Paralysed, BPF and LF’s strategic partner the Centre for Disability in Development. However many NGOs conducting CBR activities often lack the resources and funding to respond to immediate rehabilitation needs of children with disabilities. Where a major concern is preventing secondary or tertiary conditions. These NGOs depend on funding from international donors which come with limited timeline and scope of activities. Integrating CBR with the primary health care system could help make CBR activities more accessible.

Both NGOs of CRP and CDD, for example, are well-known in civil society for providing comprehensive capacity building programmes to other organizations who wish to have trained CBR workers for disability-inclusive programmes. At a recent CBR workshop held by CDD, the participants mapped out how they envision a CBR network of actors in their existing portfolio of programmes related to disability-inclusive community based rehabilitation (see Figure 2).

Figure 2 CBR mapping exercise by Centre for Disability in Development (CBR workshop, March 2024)

Various multilateral and bilateral funders - World Bank, UNICEF, EU, JICA, USAID, FCDO, JICA, among others - have supported disability programmes. The country is also home to the largest global south NGO – BRAC. Several INGOs known either in mainstream child-focused development (i.e. Save the Children, World Vision, Plan International) or disability work (i.e. CBM, Sightsavers) also operate in Bangladesh. There are about 2,500 NGOs listed in the NGO Affairs Bureau[1] officially registered, although more are unregistered.