1. CBR in Afghanistan Jenny Wickford PhD RPT

2. CBR in Afghanistan

3.  Different NGOs have been running CBR since early 1990s, byvarious different NGOs

4. CBR in Afghanistan  Different NGOs have been running CBR since early 1990s, byvarious different NGOs  CBR is implemented in 16 / 34 provinces

5. CBR in Afghanistan  Different NGOs have been running CBR since early 1990s, byvarious different NGOs  CBR is implemented in 16 / 34 provinces  Often include service provision (eg physiotherapy andassistive devices) since the government has not been able todo this

6. CBR in Afghanistan  Different NGOs have been running CBR since early 1990s, byvarious different NGOs  CBR is implemented in 16 / 34 provinces  Often include service provision (eg physiotherapy andassistive devices) since the government has not been able todo this  Undergoing change – unsure about what will happen infuture

7. CBR in Afghanistan  Different NGOs have been running CBR since early 1990s, byvarious different NGOs  CBR is implemented in 16 / 34 provinces  Often include service provision (eg physiotherapy andassistive devices) since the government has not been able todo this  Undergoing change – unsure about what will happen infuture  Rehabilitation of Afghans with Disabilities (RAD) – largestdisability programme in the country

8. Rehabilitation of Afghans with Disabilities Geographical spread

9. Rehabilitation of Afghans with Disabilities

10.  5 different components  Special and inclusive education  Information, education, communication  Vocational training and revolving loans  Physiotherapy  Orthopaedic workshops

11. Physiotherapy component

12.  Institution-based services

13. Physiotherapy component  Institution-based services  ‘Home-Based Training’

14. Physiotherapy component  Institution-based services  ‘Home-Based Training’  Community-based physiotherapy?

15. Community-based health services?  Goal of CBR in relation to health: that “people withdisabilities achieve their highest attainable standard ofhealth” (WHO, CBR Guidelines, Health Component, 2010).

16. Community-based health services?  Goal of CBR in relation to health: that “people withdisabilities achieve their highest attainable standard ofhealth” (WHO, CBR Guidelines, Health Component, 2010).  Thus, what is the role of a physiotherapist, occupationaltherapist or nurse in a CBR programme? An orthopaedictechnician?

17. Community-based health services?  Goal of CBR in relation to health: that “people withdisabilities achieve their highest attainable standard ofhealth” (WHO, CBR Guidelines, Health Component, 2010).  Thus, what is the role of a physiotherapist, occupationaltherapist or nurse in a CBR programme? An orthopaedictechnician?  DISCUSSION

18. Community-based health services?  Role of CBR in relation to health: “to work closely with thehealth sector to ensure that the needs of people withdisabilities and their family members are addressed in theareas of health promotion, prevention, medical care,rehabilitation and assistive devices. CBR also needs to workwith individuals and their families to facilitate their access tohealth services and to work with other sectors to ensure thatall aspects of health are addressed” (WHO, CBR Guidelines,Health Component, 2010).

19. Community-based health services?  Technical expertise as part of a referral system is essential forCBR programmes to function: “If following the basicassessment, CBR personnel identify a need for specializedrehabilitation services, e.g. physiotherapy, occupationaltherapy, audiology, speech therapy, they can facilitate access for people with disabilities by initiating referrals ” (WHO, CBR Guidelines, 2010)

20. Community-based health services?  Technical expertise as part of a referral system is essential forCBR programmes to function: “If following the basicassessment, CBR personnel identify a need for specializedrehabilitation services, e.g. physiotherapy, occupationaltherapy, 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 otherprofessionals etc

21. Community-based health services?  In Afghanistan, physiotherapy and orthopaedic technicianswere included by necessity, since these services are notsufficiently available within the national health-carestructures.

22. Community-based health services?  In Afghanistan, physiotherapy and orthopaedic technicianswere included by necessity, since these services are notsufficiently available within the national health-carestructures.  Present challenge – to shift physiotherapy in nationalhealthcare structures  Salary issues  Technical support challenges  Status  Less recognition of the profession within national healthcarestructure

23. Community-based health services  Present developments 2011  Expanding the training, to specifically train physiotherapists forthe national healthcare structure  Adapting the present 3-year curriculum to strengthen referralsystem and collaboration between relevant health professionals,to strengthen links with communities, and to raise awareness ofrehabilitation services

24. Community-based health services  Present developments 2011  Expanding the training, to specifically train physiotherapists forthe national healthcare structure  Adapting the present 3-year curriculum to strengthen referralsystem and collaboration between relevant health professionals,to strengthen links with communities, and to raise awareness ofrehabilitation services  Future possibilities  Institution-based physiotherapists + community physiotherapists

25. Community-based health services  Present developments 2011  Expanding the training, to specifically train physiotherapists forthe national healthcare structure  Adapting the present 3-year curriculum to strengthen referralsystem and collaboration between relevant health professionals,to strengthen links with communities, and to raise awareness ofrehabilitation services  Future possibilities  Institution-based physiotherapists + community physiotherapists  Huge challenge: to move away form dependency on NGOsas services are moved into government structures

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