CBR as it developed in the late seventies and early eighties was largely a response to the physical rehabilitation needs of many disabled people who by that time were not reached through so-called institution-based rehabilitation. CBR became an approach to make rehabilitation accessible to disabled people at the community level. CBR in those days developed from within a medical model perspective, implemented in the context of the health sector, and was concerned with coverage. CBR in those early years focused mostly on the notion of “Rehabilitation for All”, much in line with the WHO strategy of “Health for All”. There was nothing wrong with it and those who seriously want to address the vast needs of the majority of disabled people living in lesser developed countries should still take note of the early ideas. If the current coverage and access to rehabilitation services is compared with the situation some thirty years ago it may very well be that the situation on the ground has not much improved. CBR remains limited to pockets of - more or less - acceptable standards of rehabilitation services. However, all too often it is limited in terms of coverage, scope and comprehensiveness. In spite of many initiatives worldwide and in spite of renewed interest in CBR, the real situation is that the majority of disabled people do not have any access to any form of rehabilitation. Unfortunately this notion seems not to be heard anymore. It appears as though CBR is now well-accepted and applied. However, even in countries claiming to have national programmes such as Vietnam, the coverage is limited and while many provinces may have CBR (74% coverage), it is a few districts in those provinces (24% coverage) and a few villages in those districts (24% coverage) that in actual fact benefit from the national CBR programme (1). Similar examples can be given from other parts of the world. While coverage may be limited, there is also quite some evidence, probably not in the scientific literature, but certainly among those who work on the ground - that the notion of quality is a point of concern too.

Although claims have been made by some critics that CBR as presented in the eighties, was largely a top down development, the reality is that most CBR developments were and are more bottom-up initiatives managed by non-governmental organizations (NGOs), rather than by governments. A survey among 29 African countries compiled by WHO (2) suggests that there is “no national [African] programme where multi-sectoral CBR activities cover the whole country”, and CBR is mostly confined to pilot projects in some areas, with foreign funding.

CBR as it was developed in the early years - with a focus on coverage and on individual rehabilitation - became labelled as a so-called medical or individual paradigm of viewing disability, a distortion of all that was CBR. Yet, in those early years of development many official and non-official CBR initiatives were already working from within a much broader social or human rights paradigm, sometimes unaware of theoretical debates on paradigm shifts in disability, but conscious about the complexity of the disability experience and the need to respond to the felt needs of disabled people. These early CBR initiatives comprised of small parent support groups that were initiated by mothers of disabled children in rural kwaZulu Natal in South Africa; or a cooperative of men and women, all disabled, weekly making thousands of baskets in a slum north of Johannesburg in South Africa (3); or in another continent, Projecto Projimo in Mexico, one of the early CBR programmes with basically only disabled people involved in the management and execution of the programme (4). Should we retrospectively criticize such developments while it is questionable if we are doing any better in 2008?

The current forms of CBR, based on social model thinking and human rights tend to be seen as the best, the ideal or even only truly CBR. Such strategies may be seen as the only way to ensure that disabled people become part of the mainstream. Let us however, critically scrutinize such programmes and ask ourselves what the scope is of these programmes and their impact on the lives of the millions of disabled people living in absolute poverty.

CBR is - rightfully - nowadays seen as an empowering strategy. However, in view of the above remarks there should be some concern about a too pointed individual human rights focus in our work as they may create false dawns. Disabled people will not automatically have a better quality of life because of legislation only. Therefore, we should ensure that through our efforts in CBR the actual needs of disabled people are being met, and then if we meet those needs we may comply with international human rights laws such as the Universal Declaration of Human Rights (1948): i.e.,

- the so-called classical rights such as the right to live; the right to food; integrity rights.

- Socio-economic and cultural rights, such as the right to education; the right to employment; the right to Basic Health Care.