Presented at ISEC 2000

Success Story of Bangladesh Protibondhi Foundation in Mobilization of Resources for CBR Programme

Sultana S. Zaman, Ph.D Professor of Psychology & Special Education(Retd) Dhaka University, Bangladesh

Abstract

The present paper describes how in CBR programme the resources could be mobilised such as man, material and money to serve the disabled.

Taking an example of an ongoing CBR programme of Bangladesh Protibondhi Foundation in some remote villages of Bangladesh, the paper presents how mobilization of resources was possible. The CBR programme started in 1996 with door to door survey in a number of villages in Kishoregonj. Along with professional evaluation for screening and diagnosis of disability and service delivery to the disabled children, clubs were formed by parents, teachers and local people. Micro credit and savings programme were introduced among the families of disabled.

Finally "Association for the Welfare of the Disabled" was formed and funds were raised voluntarily by parents and local people. Some local people even donated their land where simple construction was made to hold meetings, training or workshop for parents etc. BPF an NGO initiated the CBR programme but with much enthusiasm the parents and local people have pooled their talent, money and material to take it forward. This is a unique example of how a community comes forward during necessity to help its weak members.

INTRODUCTION

Before presenting the success story of the Community Based Rehabilitation (CBR) programme of Bangladesh Protibondhi Foundation (BPF) I would like to discuss the concept of CBR how it has evolved to the present day and related issues. The main thrust of the paper will then be high lighted that is how the resources of MAN, MATERIAL and MONEY were MOBILIZED for the CBR programme of BPF.

The concept of Community Based Rehabilitation (CBR) programme probably arose with an alma mater declaration of 1978 by the heads of various ministries of health from throughout the world. It became apparent that it would be impossible to provide rehabilitation services unless there was a base which was built at the level of the community. Subsequent to that particular declaration the Community Based Rehabilitation (CBR) programme of the World Health Organization was officially launched in 1981, the International Year of the Disabled.

The concept of "Community Based Rehabilitation" (CBR) essentially crystallized many trends and involved all those measures taken at community level to be used and to build on the resources of the community, UNICEF began active support of CBR programmes in the poorest countries at the beginning of the 1980's, these have concentrated on disabled children and most but not all were linked with general child health services and organized social services.

The essential problems of disabled children are the same whether they live in towns or in rural areas. But just as the vast majority of poor children live in rural areas, so too do the vast disabled children, but the majority will be in rural areas and in poor urban communities. For these children the only realistic approach to policy is community rehabilitation. David Werner argues that responses to the problems of children with disabilities should be a high priority in social welfare policy. Werner further states that "Without rehabilitation of the child and the community, the disabled child is likely to become an unhappy, unemployed and possibly completely depended adult; with rehabilitation, often that same child will become a more fulfilled, more independent adult, who actively contributes to society" (Werner, 1986).

DEFINITION OF CBR

Dr. Helander, a co-author of the World Health Organization's landmark manual "Training in the community for the people with disabilities" presented his definition in Geneva at the Forum on Co-ordination of Rehabilitation Programmes Funded from External Sources.

Dr. Helander defined Community Based Rehabilitation (CBR) as a strategy for improving service delivery, for providing more equitable opportunities and for promoting and protecting the human rights of disabled people. It calls for the full and co-ordinated involvement of all levels of society: community, intermediate and national. It seeks the integration of all relevant sectors - educational, health, legislative, social and vocational and aims at the full representation and empowerment of disabled people. Its goal is to bring about a change; to develop a system capable of reaching all disabled people in need and to educate and involve governments and the public, using in each country a level of resources that is realistic and maintainable (AHRTAG CBR News, 1993).

TRANSFER OF KNOWLEDGE FROM PROFESSIONALS TO CBR PERSONNEL

The success of CBR programmes depend on a number of factors which need to be analyzed in the process of planning. Whether you start CBR through education, primary health care, integrated community development or through any other organization, professionals have to play an important role. It has to be emphasized that we need to understand the conceptual philosophy of CBR. We need to change our own professional attitude first then that of the people in the community towards disabled people. Conventionally the so called professionals tend to give more importance to the medico-model of rehabilitation, which is only one aspect of rehabilitation. Once the disabled person returns to the community then no follow-up is available and this is where the person needs most support.

A CBR programme is not going to be effective without professional involvement. But the professionals must show acceptance and appreciation of disabled people, their abilities and possibilities by sharing experiences in social and cultural activities in the community. Professionals must learn to respect their beliefs and practices without undermining their knowledge and skills which could be of great help in the process of rehabilitation (Chhetri, 1992).

From the inception of CBR in 1981 to this day there has been a major shift in the philosophical value system of the programme. Some of these have been discussed in the following paragraphs: (Price, Radio, Toga, 1999, Thomas, M; and M.J. Thomas, 1999)

CHANGES IN THE UNDERSTANDING OF COMMUNITY BASED REHABILITATION

The initial version of the International Clasification reflected the way Community Based Rehabilitation developed in the eighties. The ICIDH relied on a model where there was a progression from disease, impairment, disability and to handicap in a linear fashion. Impairment is defined as abnormality of structure or function of the body or of an organ. Disability is defined as a restriction or lack of ability as a result of impairment. Handicap is defined as a social disadvantage resulting from either impairment or disability (WHO, 1980). This classification led to an 'impairment' bias in many of the earlier Community Based Rehabilitation Programmes.

In the nineties, with the increasing conceptual shift in emphasis to accept the disabled person in the community, and to promote better human rights, the definition of Community Based Rehabilitation changed, as reflected in the 1994 Joint Position Paper of ILO, UNESCO and WHO. The changes are also to be reflected in the revised version of ICIDC to be brought out in 1999 called "International Classification of Impairments, Activities and Participation". In this version, the term 'disability', which has a negative connotation, is replaced by 'activity'. 'Handicap' is replaced by 'participation' to indicate the person's nature and extent of involvement in life situations in relation to impairment, activity and 'contextual factors', that are extrinsic factors determining participation. This classification is not linear anymore and explains the degree of interaction of the health condition and the contextual factors simultaneously on participation. (Thomas & Thomas, 1999)

CHANGE IN FOCUS FROM RESTORING FUNCTIONS IN THE DISABLED INDIVIDUAL TO CHANGING THE CONTEXTUAL FACTORS

In the nineties, the emphasis in Community Based Rehabilitation has shifted from medical rehabilitation and restoration of functioning in the individual, to manipulation of contextual factors related to social integration of the disabled person in the community. Similarly, instead of services for restorative therapy in the community, the focus of interventions has shifted to human rights of disabled people, promotion of self help groups of disabled people and their families, and change in attitude in the non-disabled population in the community.

CHANGES IN THE SIZE OF OPERATIONS OF COMMUNITY BASED REHABILITATION

Most developing countries have the need for larger coverage of services, though their resources are limited. In such situations, the resources are often spread thinly, so that the quality of services become poor. While the votaries of universal coverage hold that some services, even of poor quality, are better than nothing, others argue that poor quality of services would destroy the expectations from rehabilitation, and hence may become counter-productive. The challenge for planners in most developing countries is to see how best to achieve an 'optimum' quality of services, given the limitations of the need for large coverage and limited resources.

SOME CRITICAL ASPECTS IN PLANNING OF OF COMMUNITY BASED REHABILITATION

Planning for community participation

Community participation was considered as an essential part of Community Based Rehabilitation ever since it was promoted as a suitable approach for rehabilitation in developing countries. In practice, however, most programmes have found it difficult to achieve adequate levels of community participation for several reasons. Concepts of decentralization and bottom up approaches are relatively new in many of these countries even today.

In developing countries, it is often necessary to enhance community participation in a planned manner, from the inception of the project, keeping in mind the difficulties that can be encountered as the concept of full community responsibility is introduced. In the context of Community Based Rehabilitation programmes, ways have to be found to motivate the marginalised groups of disabled persons, their families, and communities to achieve a participatory mode of development, in which the community will assume some of the responsibilities to begin with and move on at a later stage to take on most of the responsibilities of the rehabilitation programme.

Planning for sustainability

"Sustainability" is a long term concept, that addresses people's central concerns and values, looks to the future, strengthens a community's ability to deal with change, develops processes for finding common ground, strives to benefit all members of the community, emphasize the involvement of people, improves accountability, develops a vision for the future, keeps track of the progress and meets the basic resource needs. Sustainability may be defined as the ability of the system to perpetuate itself using locally appropriate strategies, so that the system continues till its goals are achieved.

In planning for sustainability, it is important for planners to first identify the different factors that influence sustainability of a programme in its given social and cultural milieu, and then to develop strategies to improve sustainability in relation to the different factors identified through this exercise.

MODELS OF PARENT-PROFESSIONAL RELATIONSHIP

As the status of the parents of disabled children have been elevating from passive recipients to active consumer during the last two decades, the issues of parent-professional relationship in C.B.R. programme is becoming highly complex. The involvement of parents as partners in the enterprise provides a continuous system which not only reinforces the programme but also sustain effects of the programme after it ends (Bronfenbrenner 1974).

A review of the literature on Community Based Rehabilitation and parental involvement in disability services reveals a number of models which can be used to guide policy and practice (Mittler and Mittler 1983; Cunningham and Davis 1985; Appleton and Minchom 1991; Dale 1996). The models should be considered as tools for thinking rather than roadmaps for practice. Cunningham and Davis (1985) delineated three models to show relationships between parents and professionals, which they have described as the expert model, the transplant model, and the consumer model. Appleton and Minchom (1990) described a fourth model, the social network/systems model which is evident in American literature. Appleton and Minchom (1991) also described a fifth model, the empowerment model which was also quoted as partnership model (McConachie 1995). This fifth model combines the rights of a parent as a consumer to choose a service at a level which suits them personally with a professional recognition, that the family is a system and social network. Dale (1996) proposes a sixth model, called negotiating model which focuses on negotiation as a key transaction for parent-professional partnership (see Table 1).

TABLE 1 : MODELS OF PARENT-PROFESSIONAL RELATIONSHIP

Most of the developing countries possibly follow the traditional 'expert model' which is rather a top-down approach. Both, the parents of a disabled child and the professionals tend to be comfortable with this approach as most of the parents are illiterate and poor and giving the responsibility to the professionals may decrease the level of stress, they have been experiencing. In the developing countries the common conception frequently prevails that, 'the doctor knows the best' (Mubarak 1997). However the fifth model which combined rights of a parent as a consumer and empowers the parents as partners of the professionals could be a good model to be sought for in a successful CBR programme either in developed or developing country.

COMMUNITY BASED REHABILITATION PROGRAMME OF BANGLADESH PROTIBONDHI FOUNDATION

In Bangladesh there are many challenges to be overcome by professionals who attend to provide services for the young disabled children. There is high population density, with 1,000 people per square mile, and half of the population of 120 million people are under 18 years of age. It is estimated that 86% of the population live below the absolute poverty line, with infant mortality at 85 per 1000 and 50% low birth weight (UNICEF, 1997)

Bangladesh is a country of many rivers with a poor infrastructure of roads, bridges and railways, so communication are difficult. 81% of the population live in the rural areas. A large and detailed epidemiological study during 1987-88 in the late 1980's indicated that 1.6% of the child population has severe disability, which translates into 1 million disabled children under the age of 10 years (Khan et al 1995). Yet there are few services. There are a very few special schools in cities and almost nothing for children under the age of five. Therefore, there is a need for innovative thinking to develop appropriate services particularly in rural areas.

Although in a CBR programme disabled persons of all ages are served and catered for, the emphasis of the CBR programmes of BPF has been on children, as they are the most vulnerable group in terms of disability, malnutrition and mortality.

Before starting the CBR programme, BPF embarked into two significant nationwide research which finally was of great assistance and support in (i) screening the disabled children at the community level and (ii) service delivery to the disabled children at their door steps. These two researches, each of them for a period of 2 to 3 years, were as follows :

(1) The first study was the - "Rapid Epidemiological Assessment of Childhood Disabilities in Bangladesh".

Department of Psychology, University of Dhaka with the support of Bangladesh Protibondhi Foundation, Gertrude Sergievsky Center, Columbia University, New York provided collaborative assistance, carried out during 1987-88 a study to develop a rapid and low cost method for assessment of the prevalence and risk of disability in children, 2 to 9 years of age and identify possible causes. The study was aimed at developing a simple screening instrument for childhood disability.

The study was carried out in five sites of Bangladesh to validate a TEN-QUESTIONS (TQ) as a tool for screening childhood disabilities in communities where resources for disabled children was scarce if available at all. The type of disability covered by the TQP were blindness, deafness, mental retardation, motor disability and epilepsy.

A two-stage design was followed to test the validity of the TQ for screening disabilities. Stage I consisted of the household survey by community workers and screening of all children in the sample by the TQ. Stage II consisted of comprehensive professional (medical and psychological) evaluations of all children who were screened as having some problem i.e TQ positive plus a random sample of those who were screened as having no problem i.e TQ negative.

A total of 10,306 children 2 to 9 years of age from five sites of Bangladesh were screened in the 1st stage by the community workers using the TQ. The result indicated that using a simple screening questionnaire such as TQ the workload of the doctors and specialists could be significantly reduced.

However from the preliminary results it is encouraging to note that TQ also pick up conditions which could be attended immediately with intervention (such as night blindness, ear infection, mild seizure etc) before it can become a disability. The study indicated a prevalence rate in Bangladesh of 6.8% for all levels and types of disabilities (motor, vision, hearing, cognition, epilepsy) and 1.6% for serious disabilities in children aged 2-9 years. (Zaman et al, 1992) WHO and UNICEF has accepted TEN QUESTIONS as a screening instrument for disability at the community level. TQ to-day is being used for screening disability among children for CBR purpose all over the world.

(2) The Second study was entitled : "Effectiveness of Distance Training Packages for training the outreach families of Disabled Children in Bangladesh" :

The Distance Training Package (DTP) Programme is a home-center based training programme of Bangladesh Protibondhi Foundation for the parents/caregivers of the Disabled Children residing in the area where no services for the disabled children exist. Training is offered in the centre to the parents/caregivers in the overall management of their disabled child through pictorial training guides. DTP are pictorial training manual/guide which comprise of different activities sequenced in order of developmental milestones explained through simple written instruction and pictures, which are compiled in booklets called "packages". The packages have been developed in the areas of motor development, speech and language development, cognitive development, social and daily living skills (for cognitive development Portage Guide to Early Education has been converted to Portage Pictorial Packages).

The study compared the effectiveness of this low-cost intervention through Distance Training Packages (DTP) for Young disabled children in Bangladesh with a high cost centre based intervention programme. A total No. of 85 children aged between 1.5 and 5 years with disability from the urban and rural areas were selected for the study.

The result indicated that such low-cost advisory services like DTP in a country like Bangladesh show promise in helping mothers to improve the skills of their young children with disability. (Zaman et al, 1998)

INITIATING CBR PROGRAMME OF BPF

Bangladesh Protibondhi Foundation (BPF) had been providing services to the disabled children and adults through home and centre based programmes for more than a decade. The services had been extended to a large number of families of the disabled almost all over the country, even to the remotest villages through Distance Training Package Programme. The services which had been experimentally proved through several research was undoubtedly of a high quality. But the question was what percent of the disabled population who were living in the rural areas (81% of the total population live in the rural areas) were getting the services? Those who were getting the services, was there any participation of the families and community in terms of finance, or any form of support for the services? How long BPF would be able to provide one way services to the disabled with its limited resources and personnel? Considering these facts, BPF started its services for the disabled in the community through the Community Based Rehabilitation (CBR) programme in August 1996 in 20 villages of Dhamrai and Savar (45 km north-west of Dhaka city), initially and later in 30 more villages in Kishoregonj 150 km north of Dhaka city, Narshingdi 45 km north from Dhaka city and Faridpur 100 km south west of Dhaka city in 1997 and 1998.

The vision of BPF's CBR: was to help the disabled persons became self-reliant and improve their quality of life. The services of the CBR was to undertake programmes and activities to make the disabled independent and self-reliant.

The major objectives of the CBR programme were as follows :

To identify all persons with disability in the community.

To provide required rehabilitation services to disabled people.

To create awareness about all issues related to disability.

To transfer rehabilitation related skills to the community members.

To mobilize available resource and raise funds to carry out the programme. · To raise the level of community participation to an optimum level.

To make the CBR programme sustainable until the needs of the disabled people are adequately met.

To prioritize services for the disabled children.

The CBR programme of BPF were mainly targeted towards service delivery to children and prevention of high risk children from becoming disabled with a small coverage.

INITIAL SELECTION OF THE AREAS, NEED ASSESSMENT OF THE DISABLED AND ACTUAL SURVEY RESULT :

In each area selected, a number of villages were earmarked to start CBR programme. Next four or more community workers in each area with a high school education and a supervisor (who acted as a link between the CBR programme and BPF) were recruited from among the local people. Community workers and the supervisor were then trained by the professionals of BPF regarding CBR as well as TQ survey either at the central office of BPF or in the village itself.

(a) Need assessment of persons with disability

To fulfil the mission of CBR a survey was conducted by BPF in the programme areas to "Assess the Needs of the persons with Disability and their Families" with a focus on the need for the different types of intervention as well as the resources available in terms of personnel, materials, finance and technology at the Government and Non-Government level (Thomas & Thomas, 1999).

(b) Screening of disabled children by the community workers

To obtain the base line data on disability and collect information on the number, age, gender and types of disability the TQ was administered door-to-door in each household in all the villages selected, along with other questionnaires on household and community, such as health and nutritional status of children, types of disability, causes of handicap, who cares for the disabled, what is the daily activity and work load of the care giver, what is the coping strategy of the family etc.

(c) Diagnosis by the professional team :

After the administration of the TQ for screening disability in all the villages, the professional team comprising of a pediatrician, a psychologist and a special educator visited the site and medically examined and administered psychological tests on children who have been screened by the community workers with TQ. (Result has been in Table II)

BPF has been involved in CBR programme in 5 rural areas of Bangladesh in a total of 50 villages. The areas are as follows :

(1) Dhamrai (2) Savar (3) Kishoregonj (4) Narshingdi (5) Faridpur

TABLE - II Result of screening of disability in 5 areas by TQ

After the need assessment and actual survey, service delivery by the professionals and community workers started and continued and is still being pursued.

SERVICE DELIVERY BY THE PROFESSIONALS AND COMMUNITY WORKER, STARTING CLINIC FOR ALL CHILDREN AND SCHOOL FOR ALL CHILDREN :

(i) Clinic for All Children :

A team of community workers trained in physiotherapy, speech therapy and special education and also in the use of Distance Training Packages (DTP) first visited with professionals the homes of the disabled who were diagnosed as severely handicapped in the villages. The family members were trained by the professionals first and then the training continued by the community workers regularly. The professionals however supervised the programme by their periodical visits. During professional assessment by the medical team the sick children from in and around the area also started coming to the centre who were medically examined and treatment and advice given. Later the centre became a "clinic for all children in the village".

(ii) Inclusive Schools in all the CBR Programme :

As BPF's work with the disabled children became more and more known in and around the area people demanded more services for their children normal and disabled. This was a demand for 'education' of their children. Spontaneously regular "school for all children" have been opened in all the CBR programme areas where disabled children have been willingly enrolled with normal children.

(iii) Kalyani Primary School for all Children at Kishoregonj :

Kalyani Primary School for all children was started at Kishoregonj spontaneously by the parents of local children and of course BPF extended its helping hand. Construction of the school building (bamboo structure) was a joint venture by parents and BPF. Books, blackboard, exercise books, papers, educational toys etc. were contributed by the "parents club", BPF and encouragingly by the Government as well. On 8th February, 2000 through a ceremony the school was inaugurated where BPF Board members were present, the thana executive officer representative of the government and local leaders were also present as invited guests. In the inauguration ceremony, the General Secretary of BPF in her speech emphasized the necessity of "Education for All" and the urgency of starting a school for all children in that area. The big gathering of local people appreciated the concept and willingly came forward to help promote the programme of Inclusive Education by immediately announcing personal donation and help. Within one hour Tk. 15,000 were raised from among the public who came to the inaugural ceremony.

Evaluation and Monitoring of the CBR programme in Kishoregonj :

BPF's CBR team of professionals have been involved from the beginning in diagnosis of disability among children, service delivery, medical treatment of the severely handicapped children and overall improvement of disabled as well as the normal children within the community. Later the "Parents Clubs" were formed and the activities of CBR continued. Monitoring of all the activities of CBR was carried out the BPF professionals and the co-ordinator. Gradually however the professional skills were transferred to the community workers and the mothers.

Regular meeting, dialoguing between parents of the disabled, community workers and the CBR supervisor were held to discuss different issues and problems. The outcome of the meeting was reported to the CBR co-ordinater who always tried to solve the problems after discussion with the CBR supervisor. The supervisor was also responsible for monitoring the activities planned and the success of the CBR programme. This was periodically reported to the co-ordinater and assistant co-ordinater who visited the programme area once a month and or fortnightly. Every six months the CBR programme was evaluated on the basis of the following factors :

• Whether the training and activities planned were appropriate or effective in meeting specific objectives.
• Impact of the training on attitudinal changes.
• Effectiveness relating to improvement in the quality of life of disabled persons and enhancement of their participation in community activities.
• attitudinal changes towards inclusive schooling and overall improvement.

(i) Overall Improvement made by the disabled children

Evaluation was done by observing the improvement made by the disabled children and overall attitude change of the community members. The overall improvement made by the disabled children in their daily living skills was evaluated by administering the Denver Developmental Screening Test (DDST). Test after 1 year and was compared with the results of the initial test during diagnoses. One of the evaluation result obtained from some children from the villages of Kishorgonj has been given in Table III.

Table - III Comparing Test scores of DDST given during diagnosis and test scores after one year

Table - III indicated that all the 21 children who were pre-tested during diagnoses and post-tested after one year by DDST have considerably improved. Developmental Quotient (DQ) represented by the scores obtained by the children in post-test is higher than the pre-test. The attitude survey of the community by administering a questionnaire to the parents of disabled children as well as normal children, other members of the parents club, union council members, community workers was very favorable.

ii) Stimulation and Improvement :

Community is already receiving from CBR programme i.e. from BPF medical treatment and medication, physiotherapy, speech therapy and training in cognitive development through Portage Pictorial packages for their severely disabled children. As a result there has been considerable improvement found amongst these children in their daily living activities. After getting enough stimulation and training by the therapists some children have learnt to sit, walk and to speak. Some children have also been operated for their clubfoot. Others improved so much that they have started going to school. With medication and stimulation a number of "at risk" children have almost became normal. Epileptic children have stopped getting convulsions or at least it has reduced considerably. Eye sight of children who were night blind have became normal as a result of taking high potency Vitamin A tablets. Health and Family Planning awareness programme has helped many mothers in taking precaution in this regard.

(iii) 'Situation of Kalyani Primary School for All' (after six months) :

Presently there were 10 disabled children and 65 normal children i.e. a total of 75 children who were attending the school. Nursery class and grade I have been opened in the school. All children have been provided with picture books, books for numbers and vocabulary. In the courtyard of the school premises children play local games. Two teachers with high school education after getting brief training in "Inclusive Education" from BPF have been employed as teachers in the Kalyani Primary School, Kishoregonj.

Improvement noticed among the disabled children enrolled in "Kalyani School for All" within 6 months :

MOBILIZATION OF RESOURCES : TO MOBILIZE THE LOCAL RESOURCES IN TERMS OF MAN, MATERIAL AND MONEY

(I) MOBILIZATION OF THE RESOURCE MAN

(i) Formation of "Welfare Association for the Disabled" or "Parents Clubs" In each

CBR area after the first service delivery "Parents Clubs" or "Association for the Welfare of the Disabled" were formed. Besides parents of the disabled children, parents of normal children from neighboring households, teachers of local schools, women members of union council and any other person interested in the disability issue or overall welfare of the children in the village became member of the club/association. Several Clubs have been formed depending on the nearness of the villages. A chairperson has been elected by the member in each club. The local supervisor was also co-opted as a member who always attended the meetings. Each club held regular meetings at least once in a week or sometimes twice a week. Members attending the meeting sometimes exceeds 40 to 45 people.

In the Parents Club the following issues and topics were usually discussed :

(i) How was Kalyani Primary School for All running?

(ii) Were all the children receiving therapy/services in time and according to their needs by the professional team and the community workers or not.

(iii) Do any children require special medical treatment or not.

(iv) How can they help in making overall improvement of their children. (iv) Health awareness by all. (vi) Cleanliness of the environment.

(vii) Knowledge regarding better nutrition.

(viii) Disability Awareness.

(ix) How to help meet the needs of normal children as well.

(x) Advocacy of "Inclusive Schooling" among public and government sectors.

To increase community participation the "Parents Club" have been formed in a number of villages and has been extended to all interested local people. They have been willingly coming forward to become member realizing the benefits of the CBR programme.

By becoming member of this club the villagers as a whole are getting a number of benefits such as :

(i) Awareness regarding "Education for All".

(ii) Awareness regarding disability.

(iii) Awareness regarding health, family planning and cleanliness of the environment.

(iv) Knowledge regarding nutrition.

(v) The highest benefit is that the villagers are becoming united.

(ii) Community Participation

There are certain levels of community participation and we need to have clear understanding of these and the expected target of achievement after a period of time. The following table suggests a simple method of grading different levels of participation : (Thomas & Thomas, 1999)

There were five levels of community participation (See Table -IV). The levels were as follows: TABLE - IV Different levels of community participation in development projects

Amongst the five levels of participation mentioned in Table-II CBR programme of BPF has undoubtedly reached the fourth level.

(iii) BPF and the Communities as Stakeholders :

We all know and believe that community participation in a CBR programme is an essential component. However in developing countries due to economic, social and political unrests and constrain in many places community participation in CBR programmes remains at a lower level. But it is of great satisfaction that overcoming all these obstacles CBR programmes of BPF can claim to have achieved a moderate level of community participation. We could designate the communities of Dhamrai, Savar, Kishoreganj, Narshingdi and Faridpur as stakeholders as BPF is providing the disabled children of these areas medical service, physiotherapy, speech therapy, training in cognitive development (through Portage Pictorial Packages), micro-credit, counselling to parents etc. On the other hand the CBR programme is getting benefit from the community through encouragement by the local people in the form of donation of land with fund for construction of a school as well as contribution by some local people to the "Welfare Fund". And finally Kalyani Primary School for All is a big stride forward in promoting "Education for All" in that area.

(iv) Social Security for the BPF CBR team

When the CBR team comprising of pediatrician, psychologist and therapists from BPF visit the villages for few days, some local people sometimes try to create hindrance but majority of the villagers standby with them and guarantee security for the CBR team by helping them in various ways.

(II) MOBILIZATION OF RESOURCES : MATERIAL

(i) Donation of Land and construction of a centre

By observing the activities of CBR as well as the improvement made by the severely handicapped children of the villages as well as the normal children, some well-wishers of the disabled have come forward with the offer of donating piece of land as well as construction of simple structure to be used as Primary School for all and, as office or training centre for the community workers and mothers. Such structures have already been built in some areas and at present it is used as the CBR Centre in the village, as well as "School for All".

(ii) Help from villagers

The villagers have to-day become sympathetic and helpful towards the disabled children who remained totally neglected in the past. During the training sessions of the mothers the local people extend their helping hand sometimes by providing food, communication facilities, arranging places where training can take place etc. It is very clear from the present discussion of the CBR programme of BPF that no CBR programme can be sustained without community participation. We should invite more and more local people to participate in the CBR programme. Eventually we expect people from the community spontaneously come forward and take the responsibility of running the programme by contributing on their own : man, material and money for the success of CBR as well as "School for All".

(III) MOBILIZATION OF RESOURCE : MONEY

(i) Fund Raising : Some of the associations have formed a "welfare fund" for the disabled children and have opened an account in the local banks which were operated jointly by signatures of the Chairman of the club and the supervisor. This fund is being raised for any emergency required for any child.

(ii) Micro-Credit Programme of BPF

BPF has already disbursed small funds to the very poor families of disabled children, to improve the financial condition of the family. At present micro-credit has been given to 21 families - in one of the areas of CBR programme. Each family has been given Tk. 5,000/- per year. The loan is returned in installments. Only 10% interest on the principal amount was charged. The strict rules for micro-credit programme followed by other banks, as well as the "Grameen Bank" has been changed by BPF's micro-credit programme. The conditions of BPF for micro-credit are simple and relaxed so that the families are not threatened. CBR Supervisor helps and overseas whether the families are properly utilizing the loan. If necessary the supervisor gives advice to the families in how to spend the money profitably. Most encouraging thing is during the last one year BPF has received 100% recovery of the money given to the families.

CONCLUSION

CBR programme of BPF have taken into consideration before embarking into action several issues related to changes in the philosophy and concept of CBR from the past to the present which have been discussed in the introduction of the present paper. All these issues have ben successfully implemented in the programme :

Firstly the inauguration of the Kalyani Primary School is a big step forward towards the philosophy of "Inclusive Schooling". In the CBR programme areas to-day the disabled children are not seen as separate and are happily being mingled with the normal children of the villages.

Secondly participation of the parents of the disabled children in the programme have been emphasized. The parents are contributing more than receiving the services for the disabled. Moreover the professionals are trying to transfer their skills to the parents and the community workers. We have observed that Parent-Professional Partnership is also Empowerment of Parents in the CBR programme. This has also been discussed in Table -IV : Models of Parent Professional Relationship. Parents were also active members of the club and were contributing to the overall development of the CBR programme.

Thirdly the programme also gives emphasis on social integration of the disabled children into regular inclusive schools and community rather than medical rehabilitation. The parents have also been integrated into CBR by taking full responsibility of organizing "Parents Club" and bringing in parents of normal children to understand and help in their problems. This way they are contributing not only to the rehabilitation of their children but in awareness building of the community.

Fourthly As far as size of the CBR is concerned it may not be large but the quality of service is very high. Moreover in a developing country like Bangladesh and an NGO like BPF with limited resources this is the best to be achieved, that is an optimum quality of services with available resources within a small coverage.

Fifthly Community Participation has been quite successful as the local people not only have come forward and become member of the "Parents Club" but has donated lands and contributed to welfare funds.

Finally the CBR Programme of BPF have been planned and has evolved itself in such a manner that the social and cultural factors have been integrated into it. In this way sustainability has been perpetuated in the philosophy of the CBR programme of BPF, as locally appropriate strategies have been used as much as possible and therefore it was expected that the system will continue till its goals were achieved, that is the community would take over all the responsibilities (the 6th level of Community Participation given in Table -II).

The description of the total programme of CBR of BPF given in this paper gives clear evidence of how Man, Material and Money have been Mobilized for the purpose of rehabilitation of the disabled children in the Community.

Mobilization of Man : "Parents Club" has successfully integrated the parents of disabled and normal children, local union council members, other local people into their activities through awareness building and community participation. Besides the disability programme, CBR has motivated the people in health, environmental cleanliness and family planning programmes for the community members and last but not the least in inclusive school for all children.

Material and money : The CBR programme through its good and high quality services have attracted the members of the community to come forward and donate land and money for building school for all children as well as contributing money to the "Welfare Fund" of the "Parents Club".

The Community Based Rehabilitate Programme of BPF is undoubtedly a clear example of "Development of Community for All through Disability Programme", which has successfully mobilized the resources Man, Material and Money.

REFERENCE

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Index