Blog post 7 of Nusrat Zerin_When CBR Goes Wrong What to Avoid.docx

New blog post by Nusrat Zerin, a Disability Inclusion development professional:
When CBR Goes Wrong and What to Avoid - the lessons on the common traps that can weaken the Community Based Rehabilitation (CBR) for persons with disabilities, and what to avoid to make the work done.

1. Blog post on Disability and Development by Nusrat Zerin
An Educationist, Inclusion Practitioner & Disability Development Professional
2025
Title:
When CBR Goes Wrong: What to Avoid
By
Nusrat Zerin
Educationist, inclusion specialist & Disability Development Professional
2025
The Community Based Rehabilitation (CBR) of the World Health Organization (WHO) approach is
important because it helps people with disabilities live with dignity, take part in family and
community life, and reach their potential. It brings support and opportunities closer to where
people actually live. It’s appealing to say and think if we build it, they’ll come, but CBR doesn’t
work by magical infrastructure alone. Certain traps are surprisingly common, often born of good
intent but poor follow-through. Some are described here:
1.Ignoring Local Realities & Culture
Often NGOs treat cultural norms, local beliefs, family priorities as static obstacles rather than
starting points. In example, in many places, disability is stigmatised or seen through traditional
lenses, and families may prioritise basic survival (food, shelter) over assistive devices or therapy.
Community Based Rehabilitation (CBR) programmes that assume everyone will accept or even
want these interventions without first understanding what people value tend to fail.
Similarly, communication barriers are often overlooked: Deaf or intellectually disabled persons
may be left out because most of the CBR project staff don’t know sign language or simple
communication methods.
2.Overdependence on External Funding & Lack of Sustainability
NGOs sometimes start big CBR programmes aligned with the donor requirements and timelines,
then, when funds run out, the whole programme collapses. In Zimbabwe’s rural Chipinge
district, for instance, respondents noted that once big donors leave, “there will be a yawning
gap in terms of provision of resources for CBR”. Sometimes resources (financial, staff, transport)
are not secured through local systems/government, making sustainability weak. (reference:
Bongo, P. P., Dziruni, G., & Muzenda-Mudavanhu, C. (2018). The effectiveness of community
‐
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2. based rehabilitation as a strategy for improving quality of life and disaster resilience for children
with disability in rural Zimbabwe. Jàmbá: Journal of Disaster Risk Studies, 10(1), Article #442)
3.Poor and Inadequate Stakeholder/Beneficiaries Engagement & Participation
Real participation of people with disabilities, their families, and community members is
essential, but too often this is superficial. It includes only persons with disabilities with mild or
moderate physical impairments are involved and persons with intellectual, multiple disabilities
or sensory impairments are excluded. Also, planning is being done externally without real input,
meaning needs are misaligned.
4.Weak Coordination & Duplication of Efforts
When NGOs, government, health, education and social services all run separate but overlapping
CBR-elements without coordination, resources are wasted. Some areas lack a coordinating
structure, which leads to duplication, gaps, or conflicting approaches.
5.Skipping or Avoiding Follow up Training and Support
A few days of orientation, workshop or initial training does not make anything real. Skills and
knowledge need reinforcement, mentorship, and continuous capacity building initiatives.
Without this, local CBR workers or volunteers may burn out, lose skills, or apply incorrect
techniques. Also, professional backup or referral systems are often weak if the programme is
not designed with proper strategic direction.
6.Poor Monitoring, Evaluation, and Evidence
Many programmes do not define clear indicators, collect data, or evaluate what works and what
does not. The evidence base for what CBR does in different contexts remains “fragmented and
largely insufficient”. Without any evaluation, most of the mistakes continue, successes are not
scaled/replicated, and donors or governments can not see the impact to sustain or expand any
programme.
Common Mistakes Most of NGOs Make
Drawing from the above discussion, more specifically, there are things NGOs tend to regularly
mess up:
Setting unrealistic goals relative to available resources (staffing, transport, time).
Neglecting diversity of disability types - assuming physical disability equivalent to all
disabilities and not considering sensory, intellectual disabilities, mental health, multiple
disabilities appropriately.
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3. Underestimating the costs of assistive devices, transport, maintenance, follow-up and
capacity building efforts.
Make top-down programme designs or design CBR without involving the community and
people with disabilities in the planning process or decision making process.
Keeping only initial training on CBR without any refresher, no mentorship, no
professional support etc.
Weak advocacy efforts, failure to engage with government policy, legal frameworks,
inclusive laws or disabled people’s organisations or DPOs.
No plan for scaling or replication which makes the scenario worse like if NGO pulls out or
donor support ends, the programme collapses.
How to Avoid These Mistakes
To make CBR work well over the long period, here are some preparations based on lessons
learned worldwide -
I.Start with a genuine needs assessment by engaging persons with disabilities, their
families, and local leaders to understand what they see as a priority. And also to make
the programme flexible.
II.Ensure diversity in participation by including persons with various kinds of disabilities, by
creating access to inclusive communication, including often-marginalized groups.
III.Build local capacity & ownership by capacity building of local persons with disabilities
and community representatives, family members etc. not only to deliver services, but to
manage, monitor, and sustain.
IV.Plan sustainability from day one by including the government partners, community
resources, volunteers etc., and integrating CBR into local health and social services
action plans and budgets. To avoid or decrease donor dependency must be the sole
pillar.
V.Establish coordinating mechanisms by mapping all relevant stakeholders (like -
government, NGOs, DPOs, health/education sector actors), establish communication
channels, and clarify roles to avoid duplication.
VI.Continuous training & professional effort to build capacity by providing refresher
trainings, mentorship, referral system etc. to more skilled professionals where is needed.
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4. VII.Simple monitoring & evaluation by setting indicators, collecting both quantitative and
qualitative data, feedback loops with persons with disabilities, and adaptive learning
(adjust programme based on what is working or what is not).
Interesting Numbers / Facts
Many frameworks have been proposed to evaluate CBR, but no agreement has been
reached.” (Reference: A systematic review on how to conduct evaluations in community-
based rehabilitation (2013) shows that many frameworks exist for evaluating CBR, but no
consensus has yet emerged)
In some studies in KwaZulu-Natal, NGOs said lack of funding was the main barrier, while
government counterparts said lack of human resources was main barrier. (Reference:
Managers’ perceptions on the implementation of community-based rehabilitation in
KwaZulu-Natal (Blose, Chetty, Cobbing, Chemane, 2024) – NGOs cited funding as the
main barrier; government managers emphasised human resource shortages.)
Zimbabwe case: local district council had not allocated even a cent to disability issues in
that district, despite active CBR programme. (Reference: The effectiveness of
community-based rehabilitation as a strategy for improving quality of life and disaster
resilience for children with disability in rural Zimbabwe (Bongo, Dziruni & Muzenda-
Mudavanhu, 2018) – respondents said that since the CBR programme’s inception,
Chipinge Rural District Council had not allocated “even a cent” toward disability issues in
that district.)
#CBR #DisabilityInclusion #NGOChallenges #SustainableRehabilitation #CommunityParticipation
#CapacityBuilding #AvoidMistakes #InclusiveDevelopment #WHO #SDG #UNCRPD #NGOs
https://disabilityinclusion2.wordpress.com/2025/09/29/when-cbr-goes-wrong-what-to-avoid/
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