community-based rehabilitation: the generalized model
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d i s a b i l i t y a n d r e h a b i l i t a t i o n , 1999; v o l . 21, n o s . 10± 11, 522± 528
Community-based rehabilitation: thegeneralized model
REG MITCHELL*
Department of Behavioural Sciences, Faculty of Health Sciences, University of Sydney, PO Box 170,
Lidcombe, NSW 2141, Australia
Summary
This article presents an overview of a generalized approach torehabilitation services which have come to be known ascommunity-based rehabilitation (CBR). The various admin-istrative and government organizationsthat may be involved inthe delivery of rehabilitation services are identi® ed. Speci® cattention is given to the various forms of medical referralsystems that might exist. In general, rehabilitationservices areprovided at the community level but more di� cult cases, whichrequire more sophisticated approaches, are referred toinstitutions more closely allied to a central government. Thisreferral system also gives the disabled person access to morespecialized personnel and services. The sources of informationin this article consist of fundamental and formative primaryreferences from documentationprovided by the World HealthOrganization (WHO). These sources provide a valuable set ofhistorical documents detailing the idealized concept of CBR.
Introduction
There are several hundred million people in the world
who have permanent disabilities resulting from move-
ment, hearing, seeing, or mental impairments. The
precise number of disabled people is not known, but the
inability of current services to meet their needs is well
recognized. In developing countries basic services and
equipment are lacking. In developed countries people
with disabilities may have access to medical and
educational services, but they do not have equal
opportunities to participate in social and work activities.
The impact of disability on the individual is not
questioned. The impact of disability on a nation has been
analysed in developed countries where the cost of
rehabilitation is less than the cost of long-term support
for the disabled, particularly when the productivity of
the rehabilitated person is taken into account. In
developing countries the ® nancial cost to the nation has
not been analysed in the same way. However, there is no
doubt that disability has an impact on families who have
* e-mail: R.Mitchell! cchs.usyd.edu.au
a disabled member. Families bear much of the cost of
treatment for their disabled member. This cost often
includes transportation to take the disabled member to a
centre for treatment, appliances and } or equipment. In
addition, there is often a loss of income for the family
because one member remains at home to care for the
member with the disability.
Countries which take action to assist their citizens with
disabilities are motivated not only by economic loss, but
also by the belief in equality. All citizens, whether they
are disabled, elderly, or very poor, have the right to
health. This right includes the right to grow physically,
psychologically, and socially in the most normal way
possible. To provide for the rights of all citizens a nation
must provide for the healthy development and well-being
of its disabled citizens.
Rehabilitation is a process which assists people with
disabilities to optimize the use of their physical, mental,
and social abilities. This means that rehabilitation is
multi-faceted. For example, at one point in the life of a
child with a movement disability the most crucial need is
for training and equipment for mobility. For a child who
cannot hear, the ® rst priority would be training for
communication. Both children, at a later period in their
lives, will need education or training for work inside or
outside the home. Both want to participate in the social
activities of their families and communities. The total
rehabilitation process will require diŒerent types of
services, as well as community action.
To provide the variety of rehabilitation services is not
an easy task in any country. The health-care services ® nd
it necessary to provide special personnel for services to
people with disabilities. The eduction system ® nds that
many disabled children can be integrated into their local
schools, but often the teachers require special infor-
mation in order to provide these children with a
meaningful education. Some people with disabilities can
have occupational training alongside the non-disabled.
However, others need special training and adapted work
places.
Disability and Rehabilitation ISSN 0963± 8288 print} ISSN 1464± 5165 online # 1999 Taylor & Francis Ltdhttp:} } www.tandf.co.uk} JNLS } ids.htm
http:} } www.taylorandfrancis.com} JNLS } ids.htm
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CBR: the generalized model
To coordinate and to distribute services to all parts of
a country poses further di� culties. Perhaps one type of
rehabilitation service is more readily available within a
country than other services. For example, an
organization may be prepared to develop vocational
training programmes, but people with movement dis-
abilities are unable to obtain the necessary equipment,
such as braces or wheelchairs, to assist their mobility
between home and work. Likewise, medical rehabili-
tation services may be provided within a few centres, but
these services reach very few of the disabled in isolated
and rural communities. Even those who live in urban
communities may have services only within centres, and
not have the assistance necessary to make adaptations in
their homes and local communities.
The idealized CBR model
Most CBR programmes have developed along a three-
tier manpower structure. This type of structure appears
to be the most eŒective method of carrying out the
various activities in an integrated CBR programme.
Training of manpower varies from country to country
and depends upon the availability of resources such as
money, technology, expertise, materials, scope of the
CBR programme, coverage of management, and co-
ordination.
The three tiers that have emerged in the model are
directly associated with various levels of government."
These tiers, a simpli® ed organizational model and the
management structure are presented in table 1. The
model presented in the table assumes that there are in
place integrated national (central), regional (district) and
local (community) policies regarding CBR. While the
various Ministries listed in the above structure are
Table 1 Organizational model for community-based rehabilitation
Location O� ce Collaborators
Central Ministry of Health,
Primary health-care
system, national CBR
coordinator
Other ministries such as
Education, Labour,
Agriculture,
Economic, Planning,
etc.
District Ministry of Health,
PHC team, CBR
district team
Education, etc. as
above
Community Community health
workers, family
trainers, disabled
person, community
members
Health centre
essential to the operation of CBR there are essentially six
key players in the CBR. First and foremost are the
disabled persons themselves, and although presented as
second-last in the table this is, in fact, the person who
should be at the top of the model.
The focal person in the CBR programme is the
disabled person. There are many roles that the disabled
person will play in the rehabilitation process and among
these will be :
(1) the right to self-determination;
(2) to be self-motivated to become an active and
responsible family member ;
(3) to enjoy the bene® ts of family membership ;
(4) to be an active and responsible community
member ;
(5) to enjoy and use the same opportunities that are
available to all community members such as access
to education, skills training, work and recreational
activities;
(6) to give serious consideration to becoming a family
trainer for another disabled person, but at least be
prepared to play a signi® cant role in the CBR
programme ;
(7) to participate in the organizations which cater for
disabled persons, acquire leadership skills, con-
tribute to the achievement of community, regional
and national health goals, and act as a lobbyist for
the disabled and their families.
Services in CBR
The services considered to be medical rehabilitation
are those which: (1) promote normal development for
babies and small children with disabilities, (2) provide
training and equipment for self-care and mobility for
those with movement disabilities, and (3) provide
language and speech training for individuals with
neurological impairments. # Hence, medical rehabilitation
services may follow some individuals with movement
disabilities throughout their lives. Education services
provide training for cognitive and language development
for older children with learning, hearing, or visual
impairments.
Each Ministry of Health (MOH) should have a
national plan for medical rehabilitation services. In some
countries it is not feasible for the MOH to provide all of
the services because of government policy regarding
implementation of services, or because of ® nancial
restrictions. Nonetheless, the MOH provides a national
rehabilitation plan and then coordinates government
and non-government services so that they both con-
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tribute to the expansion of medical rehabilitation services
throughout the country. The MOH can also use the
national plan as a basis for seeking donor funds to
support the development of the medical rehabilitation
services. In particular, donor funds can be sought for
capital costs, while the MOH sustains the running costs
of the programme.
In this description oŒ the medical rehabilitation
components it is suggested that the rehabilitation
workers at district and community levels be within the
health-care system. However, these workers may be
personnel from another ministry, such as Social AŒairs
or Community Development, or from a non-government
organization (NGO). Then it is important to coordinate
medical rehabilitation services with the other services at
district and community levels.
The development and distribution of services can be
done eŒectively and e� ciently when they are expanded in
response to needs at the community level. CBR provides
a framework for developing and distributing all types of
rehabilitation and for ensuring that services reach
disabled people in their communities.
Resources in CBR
CBR has as its unique feature the use of family and
community resources for the rehabilitation of people
with disabilities. Knowledge and skills for basic training
of disabled people in functional activities are given to the
families of disabled people, to disabled adults, and to
community members. $ A resource person for rehabili-
tation is available at the community level. Disabled
children attend the local school. Within local work
settings, community members provide occupational
training for disabled adults. Community groups assist
the families of disabled people by providing child care,
transport, or loans to start an income-generating project.
Community leaders provide opportunities for disabled
people to participate in the social and political activities
within the community. These resources for the disabled
are supported by referral services within the health,
education, labour, and social services systems. Personnel
skilled in rehabilitation technology train and supervise
community workers, and provide the necessary skilled
interventions for speci® c individuals when basic training
techniques are not su� cient.
The process of rehabilitation provides disabled indi-
viduals with the opportunity to develop their physical,
mental and social skills. The goal of rehabilitation is
disabled people’ s participation in normal roles within
their families and communities. Fragmented rehabili-
tation services which do not reach the community level
are less likely to either provide or stimulate the necessary
opportunities for disabled people to participate in normal
roles. The development of services at the community
level through the mobilization of community resources
provides disabled people with the variety of assistance
they require, and does so in the setting where the goal of
rehabilitation can be achieved in the home and the
community.
Both the mobilization of community resources and the
provision of referral services are needed to achieve the
goal of rehabilitation. In developed countries, where
many referral services are provided, the use of com-
munity resources may need to be strengthened. In
developing countries the mobilization of community
resources and the expansion of referral services can be
simultaneously strengthened. The community cannot
meet all of the needs of people with disabilities, so some
referral services should be available in a region before the
development of the CBR programme is initiated.
What is essential to support the community eŒorts will
vary from country to country. However, there are some
conditions which will facilitate the implementation of
CBR. These conditions include:
(1) community leaders and organizations will support
the programme with the understanding that they
will contribute to it;
(2) a cadre of community workers will be available for
rehabilitation;
(3) personnel who will train and supervise this
community workforce will be available;
(4) resources will be available to train and post
personnel in referral services ;
(5) referral services will be able to provide basic
appliances and equipment.
Government involvement in a CBR programme
Plans for a national CBR programme may be initiated
by one or more ministries. In some countries this will be
the ® rst step in establishing CBR. In other countries
national planning may be stimulated by the existence of
CBR projects which have been initiated at the com-
munity level by NGO’ s. In either situation it is ideal to
have joint planning at the national level by all Ministries
involved in rehabilitation, although one may take the
lead as initiator and co-ordinator of the national
programme. % ± ’
Each Ministry that provides rehabilitation services will
have its own plan for the distribution of services from
central to community levels. Depending on the country,
and on the Ministry, this may include central, provincial,
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CBR: the generalized model
district and community levels. At the central level each
Ministry may have a service staŒed by specialists, e.g.
medical, educational, or vocational. Specialists may also
work at the provincial level. At district level rehabili-
tation staŒwith less training than the specialists may
oŒer some technical services and coordinate the services
between the community and the referral system. The
description below refers to developing countries, where
there is a need to develop referral services for all aspects
of rehabilitation.
However, in both developing and developed countries
there is concern about the rights of disabled people.
Many disabled people lack the opportunity to participate
in education, work, or social activities. This may be the
result of many factors, including negative attitudes and
lack of expectations about what disabled people can do,
lack of necessary appliances or equipment, and physical
barriers preventing access to buildings.
Although developed countries may have adequate
medical rehabilitation services, many of them do not
have active community components in their rehabili-
tation programmes. The lack of community awareness
and involvement in rehabilitation contributes to the
continued restriction of opportunities for disabled
people.
The Ministry of Health may have a medical re-
habilitation centre, or a rehabilitation service located at
a large central hospital. There may also be a university or
private hospital which oŒers rehabilitation services.
Within these services there are physicians with specialities
related to rehabilitation, such as orthopaedic, neurology
and psychiatry ; physical, occupational and speech
therapists ; and prosthetists } orthotists.
Within a national CBR programme the Ministry of
Health has a team at national level that takes re-
sponsibility for managing the distribution of medical
rehabilitation services at all levels. The team would
include a physician, therapist, and prosthetist } orthotist.
Their responsibilities include planning for services
throughout the country, training staŒ, and organizing
the system for supervision of staŒand referral of clients
for services. In addition, there are staŒat the central level
who provide specialized services to disabled people
referred from the provincial level. The services within the
central facility should be coordinated. If services for a
particular type of disability exist in several centres, it
would be preferable to develop only one of the centres as
a referral service in order to avoid duplication of
equipment and training. For example, services for people
with amputations might be expanded at one centre, while
services for children with cerebral palsy are expanded at
another centre.
The Ministry of Education may have special schools
for children with mental retardation, blindness or
deafness. In some countries the special schools are not a
government service, but are provided by NGO’ s. The
schools are often located in urban areas. Many are
residential because the lack of transport makes it
impossible for children with disabilities to travel each
day between home and school. Within these schools
there may be a few teachers who are special educators,
trained to teach children with a speci® c type of disability.
The other teachers may have had training on the job
from the special educators. There may be no service in
the regular school system for children with disabilities.
Within a national plan for CBR the Ministry of
Education promotes the integration of disabled children
into the local schools and provides specialists as resources
for the regular school system. This provides more
disabled children with the opportunity to attend school,
and also allows them to stay with their families rather
than in an institution. The specialists train teachers in
methods which can be used for teaching visually, hearing
or mentally impaired children within the regular school.
These special teachers may also be available to assess
children with impairments and make speci® c recom-
mendations to the teachers in the local schools. The
Ministry of Education may also organize the distribution
of some special schools for children with various types of
disabilities. This may be done by working with NGO’ s
and encouraging them to place schools according to a
national plan.
The Ministry for Labour or for Social AŒairs may be
responsible for vocational training for people with
disabilities. This task may be carried out within the
training programmes available to non-disabled indi-
viduals. Sometimes NGO’s provide this service for
disabled people who require special training or an
adapted workplace. Often vocational training centres are
located in urban areas, and are not readily available to
people from rural areas.
Within a national plan for CBR, the Ministry
responsible for vocational training will coordinate the
expansion of government and non-government
vocational training programmes so that eventually they
are available to people with disabilities throughout the
country. This will include orienting staŒin all vocational
training centres to the needs of people with disabilities. It
will also include training community organizations
involved in job training or income-generation projects so
that they can include the disabled in their programmes.
The Ministry of Social AŒairs or Social Welfare may
also be responsible for social support programmes for the
disabled, such as disability payments or the provision of
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funds for special equipment. These services will be
available through the social welfare o� cers, who may be
posted at national, provincial, and district levels.
Within each Ministry involved in rehabilitation, the
services provided are specialized, with a focus on speci® c
types of disabilities, or on particular aspects of disability.
Within these specialized services there may be little
attempt to coordinate all aspects of rehabilitation needed
by one individual. If the individual, or family, pursues
each type of service independently, the person’ s needs
may be met. However, very often it is only the most
obvious needs that receive attention. For example, a
child is provided with a brace for walking, but no-one
explains to the family what opportunities might be
availablewhen the child is older so that the young person
can have training for income production. This lack of
coordination may be particularly marked within the
central services, based in large urban areas where the
staŒand location of each type of service is geographically
separated from all other services. At district level there
may be more communication, and hence more referrals,
among staŒof health, education and social services.
The concept of CBR must be applied within the
central services as well as at provincial, district and
community levels. This requires the coordination of
services, and the activation of the community within
urban as well as rural areas. The central services cannot
coordinate services only for other levels; they must also
coordinate their own work so that people with disabilities
in the urban areas also have assistance for the complete
process of rehabilitation.
Government or non-government organizations Ð the
provincial level
In this article there is reference to only one level of
health services between central and district. The term
`provincial ’ is used to refer to the services immediately
under the central level, although many countries use
diŒerent terms such as regional or state to refer to this
level.$ , ( , )
In a CBR programme the provincial medical, edu-
cational and vocational services will each be distributed
as equally as possible. StaŒbased in provincial centres
will have the responsibility to provide direct services to
people with disabilities, and also to supervise the services
at the district and community levels.
Within the medical services, routine procedures for
rehabilitation will be carried out by physicians, therapists
and prosthetists } orthotists. Disabled people with com-
plicated or unusual conditions will be referred to the
central facilities. Provincial services will be provided to
clients referred from the district-level services. An
important role for some of the rehabilitation staŒwill be
the training and supervision of rehabilitation workers at
district and community levels.
A few special schools and vocational training centres
for the disabled may also be located in provincial
capitals. These are likely to be managed by NGO’s, but
located according to a national plan for distribution of
the services. Children or adults who wish to bene® t from
education or training, and who do not live in the larger
cities, have to reside at the school or training centre.
District level
The word `district ’ does not have the same meaning in
all countries. In larger nations it may encompass a
population of one million people, while in a smaller
country a district may have a population of 100000. In
this article the discussion of `district ’ refers to the area
covered by the ® rst referral level hospital.# , * , " !
Within a CBR programme the district is a key point in
the delivery of rehabilitation services. District-level staŒ
for health, education, and social services can coordinate
their own work in order to support the community
eŒorts in rehabilitation. StaŒat district level can travel to
the communities within the area to supervise community
workers and to visit disabled people in their homes. A
district centre is geographically accessible to most people
in the area, including those with disabilities. This
provides ® rst referral level rehabilitation services to
people with disabilities.
For the provision of medical rehabilitation services,
some Ministries of Health are employing `mid-level ’
rehabilitation workers (MLRW) at the district level. This
level of personnel is often trained to carry out the basic
tasks associated with physical and occupational therapy.
Some countries call this cadre rehabilitation assistants,
or rehabilitation technicians. The MLRW work in the
district hospital, with periodic supervision from a
physical or occupational therapist from provincial level.
In a CBR programme the MLRW are trained to work
not only with people with locomotor disabilities, but also
with people who have sensory or mental impairments.
The interventions consist of early detection of these
impairments in children; assessment of impairments or
disabilities in children or adults; and recommendations
to disabled people, their families, and community
workers regarding training to improve mobility, com-
munication and learning.
In addition to technical training for CBR, the MLRW
are trained for management and supervision. The
management responsibilities include record-keeping and
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CBR: the generalized model
reporting on the community and district rehabilitation
services, and the coordination of referrals to other levels
of the medical rehabilitation services, and to other types
of services, i.e. educational, vocational, and social. The
MLRW also supervise the work of a person in the
community who is a contact for disabled people and
their families. This may be the community health worker,
a representative for another government programme, or
a volunteer. Depending on the background of the
rehabilitation worker at community level, and what
other responsibilities that person has, the MLRW may
also have to work with community leaders and
organizations who actively support the rehabilitation
process for people with disabilities.
Community level
In communities in developing countries, where few
referral services for rehabilitation exist, families take the
initiative to rehabilitate their children, or adult members,
who have disabilities. In many instances the activities
carried out by the family are eŒective in training a child
to do self-care activities, or to move around. However,
left alone in their eŒorts, the family may have di� culty
in training or communication, preventing deformities,
providing appliances or equipment to aid the disabled
person, and integrating the child into the local school, or
the adult into normal community activities.$ , " "
In a CBR programme, disabled people and their
families receive support and encouragement as the
disabled person goes through the rehabilitation process.
They can gain knowledge and skills from the community
worker, and also from the MLRW if the knowledge of
the community worker is insu� cient. Local school
teachers receive information about disabled children and
how to include them in their classes.
Most characteristic of a CBR programme is the active
role played by disabled people and the contribution of
community members to the rehabilitation process.
People with disabilities are active in their own re-
habilitation, rather than passive recipients of services.
They are active in their own rehabilitation because it
takes place in their own homes and communities, so they
can identify what services are needed to assist them there.
Individuals with disabilities can also be active in assisting
other disabled persons in their communities, and in
advocating for the needs of all people with disabilities.
Through education programmes, and seeing disabled
people become active, the community learns about
causes of disability, and understands better the abilities,
as well as the limitations, of people with disabilities.
Attitudes towards disabled people change. Community
members receive information about skills training and
income-generating projects which include people with
disabilities. Members and organizations of the com-
munity oŒer opportunities to the disabled to become
active participants in social, work, or political activities.
The community rehabilitation worker (CRW) may be
the community health worker, in which case the medical
rehabilitation services have the most direct link for
training and supervision. However, the CRW may be a
volunteer just for the purposes of rehabilitation; a
member of another organization, such as the Red Cross ;
or a worker from a Ministry other than Health (e.g.
Social AŒairs or Community Development). If the CRW
is not part of a Ministry related to rehabilitation, an
agreement should be made regarding the direct line of
supervision for rehabilitation. Also, when the MLHW is
part of the health services, this person is the best
prepared to supervise the CRW. While it is necessary to
have one supervisor for the CRW, it is also necessary to
recognize the variety of activities that this person may
carry out in the community, and the need to have
information from all rehabilitation services reach a
community through the CRW. A more comprehensive
description of manpower and manpower training in
CBR can be found in WHO publications." #
Conclusion
The material presented above outlines the idealized
model for the delivery of CBR. The WHO support for
CBR began in 1978 and they developed a manual for
CBR through a process of ® eld testing, revision and
further testing. The 1979, 1980, and 1983 editions of the
manual were translated and used in many countries in
Asia and Africa, either by government rehabilitation
programmes or non-government organizations.
The activities of the WHO and Member States re¯ ect
a priority on prevention rather than rehabilitation.
Within the WHO the number of primary prevention
programmes is greater than the number of programmes
concerned with rehabilitation. The WHO has not
assessed a number of aspects of rehabilitation, including
integration of disabled children into local schools, special
education, or vocational training for people with
disabilities. However, it appears that the momentum of
the activities begun in 1981 during the International Year
of the Disabled Person has not been maintained with
regard to any aspect of rehabilitation. The International
Year created public awareness about the needs of people
with disabilities. However, very few countries have
established CBR as a component of either primary
health care or an expanded medical referral service.
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Where CBR has been implemented there is clear
evidence that the majority of these programmes are still
in the pilot stage. There has been no comprehensive
evaluation of CBR programmes to identify its strategic
strengths and weaknesses. Despite the ideal model
presented in table 1 there has been a lack of coordination
among service providers, primary health-care pro-
gramme components, and between government and non-
government organizations.
However, all is not doom and gloom. The CBR
concept is and has become an excellent tool for
improving the participation of disabled persons in
decision-making and facilitating their integration into
society. CBR, where implemented, has made a signi® cant
social impact on the lives of disabled persons, particularly
those in remote and rural areas. Through the increase of
public awareness about disability there is an expectation
that there will be greater community support for the
disabled and that the community will mobilize resources
(manpower, materials, money) to support the disabled
person.
Many of the reported disadvantages and advantages
of CBR are based on anecdotal evidence and, apart from
bringing rehabilitation to all disabled persons, there is an
immediate need to comprehensively evaluate CBR.
Given the vested interests of governments and non-
government organizations such an evaluation should be
initiated and supported by organizations such as the
WHO or the World Bank.
References
1 Zhuo D. Response from Jim Hua Street to the challenging CBRtasks in the 1990’s. In Report: Intercountry Workshop on Planningand Management of Community-based Rehabilitation Programmes,Manila: World Health Organization, July 1991.
2 Kalinowski Z. Development of community-based rehabilitationservices: review of the experience from the Lao PDR and otherAsian countries. In Report: Regional Working Groups on AppliedResearch on Community-based Rehabilitation. Manila: WorldHealth Organization, December 1998.
3 Valdez L. A development program in Negros Occidental. InReport: Intercountry Workshop on Planning and Management ofCommunity-based Rehabilitation Programmes in the South Paci® c.Manila: World Health Organization, RS} 91 } GE } 38(FIJ), 1992.
4 Nhan DK. Speed up the pace of community-based rehabilitationresearch. In Report: Regional Working Groups on Applied Researchon Community-based Rehabilitation. Manila: World HealthOrganization, December 1988.
5 Moon SM. Community-based rehabilitationproject in the Republicof Korea. In Report: Regional Working Groups on Applied Researchon Community-based Rehabilitation. Manila: World HealthOrganization, December 1988.
6 Wang L. Regional overview: the role of WHO in disabilitypreventionand rehabilitation.In Report: Intercountry Workshop onPlanning and Management of Community-based RehabilitationProgrammes in the South Paci® c. Manila: World HealthOrganization, RS} 91} GE } 38(FIJ), 1992.
7 Kim YH. Community-based rehabilitation in North WanjuCounty. In Report: Intercountry Workshop on Planning andmanagement of Community-based Rehabilitation Programmes.Manila: World Health Organization, RS} 91} GE} 10(CHN), 1991.
8 Nam KJ. Rehabilitation programme in the Republic of Korea. InReport: Intercountry Workshop on Planning and Management ofCommunity-based Rehabilitation Programmes. Manila: WorldHealth Organization, RS} 91 } GE} 10(CHN), 1991.
9 Guanghua H. Development of community-based rehabilitation inGuandongProvince. In Report: Intercountry Workshop on Planningand Management of Community-based Rehabilitation Programmes.Manila: World Health Organization, RS} 91} GE} 10(CHN), 1991.
10 Nguyen TN. A report on the implementation of a community-based rehabilitation programme in Vietnam. In Report: RegionalWorking Groups on Applied Research on Community-based Re-habilitation. Manila: World Health Organization, December 1998.
11 Hornblow AAR. Christchurch psychiatric epidemiologicstudy: useof mental health services. New Zealand Medical Journal 1990; 103:415± 417.
12 WHO. Discussion paper No. 6: Manpower training. Paperpresented at Intercountry Workshop on Planningand Managementof Community-based Rehabilitation,Guanzhou, Guandong Prov-ince, People’s Republic of China, 1991.
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