Community Based Rehabilitation Project (CBR)

Community Based Rehabilitation (CBR) is a community development strategy, initiated by WHO, that aims at enhancing the lives of persons with disabilities (PWDs) within their community. It is a multi-sectoral approach working to improve the equalisation of opportunities and social inclusion of people with disabilities while combating the perpetual cycle of poverty and disability. CBR is implemented through the combined efforts of PWDs, their families and communities, and relevant government and non-government health, education, vocational, social and other services (WHO). 

Wellspring’s present multidisciplinary team consists of 2 qualified Ugandan physiotherapists, a social worker and an orthopaedic officer only. We also partner with Mbarara University to offer internship placements to students enrolled in disability-related courses which helps to raise awareness for disability and build a more inclusive society within Uganda. 

In 2022 Medcare was provided with over £50,000, through the Emmanuel Cohen legacy, to fund a CBR project in and around the Wellspring Children’s Medical Centre. 

Our main goal is to ensure children with disabilities have access to equal opportunities and can thrive without stigma and discrimination in their communities using a holistic, community-based approach which includes: provision of specialist therapy services, improving the nutritional status of children with disabilities suffering from malnutrition, provision of essential epilepsy assessment and medication, providing training to raise awareness of disability amongst community members, providing support to caregivers through parent education and peer support groups, providing training to healthcare workers and teachers and providing economic empowerment training to caregivers of children with disabilities.

The Wellspring department of physiotherapy is 10years old and well known for its tremendous work and services it provides to the precious special needs children in the greater Masaka districts at a completely free cost courtesy of Medcare funds. After ten years of operation it has continued to be the only unit providing specialist paediatric physiotherapy services in the greater district.

Physiotherapy is an essential part of treating many disabilities. Movement and function can often be impaired by physical limitations that may be the result of birth injuries and complications, accidents or illness. Improving a child’s ability to complete the smallest or simplest of tasks, such as sitting upright or holding a cup, can significantly change the level of interaction that is attainable within the family unit. 

Raising awareness to transform lives 

Lack of knowledge and poor awareness of disability issues among families, communities and healthcare workers in Uganda has created a situation where disability often means a relinquishment of rights and an acceptance of reduced access to services such as education, health care and leisure activities. We have worked to create equal opportunities for children with disabilities through a range of training programmes at the centre. 

A sense of isolation is one of the most heartbreaking impacts we have seen among parents of children with special needs who are often shunned by neighbours and relatives due to widespread beliefs that disability is contagious or an untreatable curse. Transforming parents ‘culturally imposed shame into a feeling of pride and empowerment is one of our main focal points, one that we concentrate on at our regular parent education and peer support groups. 

Many of the parents that come to the Wellspring physiotherapy department have become timid and withdrawn as a result of the exclusion they feel from their community caused by a lack of understanding about their child’s disability. 

We bring parents from the same community together to discuss the issues they are facing individually, and to come up with solutions as a group. Not only does this allow for experiences to be shared and discussed in a non-judgmental, non-prejudiced environment, it also strengthens the intra-community network by encouraging parents to come together in support of one another. 

Early intervention programme 

Acting early ensures that both parents and their children are given the best start and have access to all the information and support they need to ensure bright and positive future. We try to provide early intervention training to community and healthcare workers who find their way to the centre. 

Learning about the normal child development stages, and being able to identify disabilities or high risk of disability in infants and young children, helps community and health workers provide timely health education to parents and caregivers, which can greatly improve the wellbeing and long-term developmental outcomes, and reduce the risk of secondary disabilities, neglect and malnutrition. 

Multi-disciplinary specialist care 

Disability can present itself in many forms, such as a physical impairment, impairment hindering communication or one affecting mental cognition. To make sure that every aspect of a disability can be addressed, it is necessary to have multiple angles from which to approach it. Wellspring presently only has physiotherapists leaving out other components of the rehabilitation multi disciplinary team. Wellspring lacks other specialists of the MDT such as Occupational Therapy, Speech and Language therapy but aims to employ these additional medical personnel with financial assistance from the Emmanuel Cohen legacy.

"Public attitude and empathy are very important in approaching all children with disabilities. At the same time, one of the important requirements in our daily lives is to have a socially accessible infrastructure for everyone. It is also desirable to have a more sensitive and caring attitude towards people with disabilities, especially children, within our communities, and to use the right descriptive words in relation to them. 

Wellspring Children’s Medical Centre CBR program will provide individual and group rehabilitation sessions for such children, and as a result of working with their parents, significant progress will be made in the lives of those children: from acquiring basic toileting skills to extensive communication skills, from art skills to reading skills. 

Such successes within the framework of the programme not only will increase the self-reliance and mobility of children, but also play an important role in the formation of the right attitudes and perceptions towards them in society. Disability should not hide anyone's talent and isolate them from society. On the other hand, the program will be important in enabling people with disabilities to take an active role in public life.”  Ibrahim and Pascal, Wellspring senior physiotherapists

“Disability should not hide anyone's talent and isolate them from society.” 

In 2023 a van has been purchased to be used in the CBR outreach programme. Various village communities have been identified where these outreach clinics will be based. In additional funds have been provided for the purchase of rehabilitation equipment, and educational and nutritional supplies. 

This project is currently funded for 2 years.