Community-based service delivery in rehabilitation: the promise and the paradox

Disabil Rehabil. 2000 Jul 10;22(10):435-45. doi: 10.1080/09638280050045901.


Purpose: According to many researchers, rehabilitation is being prevented from developing as a distinct profession due to two major problems. First, it has been claimed that rehabilitation is in need of a professional identity and a sense of cohesion if it is to emerge as a discipline. Second, it has been recognized that there is a need for a rehabilitation framework to challenge the restorative approach that continues to dominate rehabilitation, linking it back to the medical model from which it has attempted to escape. The model of community-based rehabilitation (CBR) is offered as a model that can provide the impetus for an attitudinal shift from the restorative tradition and unite rehabilitation workers through a cohesive framework.

Method: Unfortunately, the implementation of community-based rehabilitation in urban societies has been disappointing. The current paper is a conceptual discussion of community-based rehabilitation that explores some potential causes of this poor implementation.

Results: To some extent, the implementation failure of community-based rehabilitation can be attributed to the paradoxes that are inherent in its fundamental constructs-empowerment and community inclusion. These paradoxes occur at a conceptual level, a practical level and a contextual level.

Conclusions: Some solutions are offered to enable the paradigm to be implemented more fully. In particular, it is suggested that there is a need to develop useful working definitions of these constructs, favourable attitudes among rehabilitation workers and a focus on community development.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Community Health Services / organization & administration*
  • Delivery of Health Care*
  • Humans
  • Models, Theoretical*
  • Patient Participation
  • Rehabilitation / organization & administration*