CBR MATRIX

SNEHA MANDAR

1
• Developed by the World Health Organization (WHO), the CBR Matrix is a
framework established in 2004 for implementing Community-Based
Rehabilitation (CBR) programs, particularly in low-resource settings.

• It emphasizes inclusion, empowerment, and multisectoral collaboration to

improve the quality of life for people with disabilities, including those with
mental health conditions.
 Components of the CBR Matrix
• The CBR Matrix is structured around 5 key components, each with 5
elements, forming a holistic approach to rehabilitation.
4
 Health
• Focuses on improving physical and mental well-being through accessible
healthcare.
1. Promotion
2. Prevention
3. Medical Care
4. Rehabilitation
5. Assistive Devices
• Health is one of the most important component of CBR matrix.

• The main aim of CBR is to help People with disabilities (PWDs) achieve
their highest attainable standard of health by addressing the five elements of
the health

• CBR personnel has to work with family members along with the individual
to help them get proper access to health services and ensure that all the
aspects of the health are well addressed
1. Health Promotion

• focuses on the importance of health

promotion for PWDs by facilitating the
access to health promotion activities and
implementing basic activities wherever
necessary.
• Health promotion changes the wide
range of determinants of health and
involves many sectors and not just the
health sectors.
• Desirable outcome:
– Health promotional information provided to PWDs, their family members and
members of the general community are same.
– Health promotion materials and programmes incorporate the special needs of
PWDs.
– PWDs and their families have proper knowledge, skills and support to help
them to achieve good level of health.
– People related to health care system have improved awareness about the general
and specific health needs of PWDs and respond to the issues through relevant
health promotional activities.
– Supportive environment is created by the community for PWDs to get enrolled
in the activities which enhance their health.
– CBR programmes value good health and undertake health-promoting activities
in the workplace for their staff.
2. Health Prevention
• Goal: to stop health conditions from occurring (primary prevention).

• However, prevention also involves early detection and treatment to stop the
progression of a health condition (secondary prevention) and management to
reduce the consequences of an existing health condition (tertiary prevention).

• mainly focuses on primary prevention.

• Desirable outcome:
– PwD and their families have proper information and services aimed at health
prevention.
– PwD and their families adopt the healthy behavior and lifestyle to reduce the risk
of developing health problems.
– PwD are included and participate in primary prevention activities, e.g.
immunization programmes, to reduce their risk of developing additional health
conditions or impairments.
– All community members participate in primary prevention activities, e.g.
immunization programmes, to reduce their risk of developing health conditions or
impairments which can lead to disability.
– CBR programmes collaborate with the health and other sectors, e.g. education, to
address health issues and provide support and assistance for prevention activities.
3. Medical care
• Goal: provide proper access to medical care both general and specialized based
on their individual needs.
• Desirable outcome:
– CBR personnel have adequate knowledge about medical care services and referral for
general or specialized medical care.
– Persons with Disabilities and their families have access to services(screening and
diagnostic) that focuses on early identification of health conditions and impairments.
– Establishment of inclusive medical care service and have improved access for PWDs.
– Persons with Disabilities have access to surgical care for impairment correction and
minimization.
– Persons with Disabilities and their families develop self-management skills whereby
they are able to ask questions, discuss treatment options, make informed decisions
about medical care and manage their health conditions.
– Medical care personnel have increased awareness regarding the medical needs of
Persons with Disabilities, respect their rights and dignity and provide quality services.
4. Rehabilitation

• Goal: to provide access to

Persons with Disabilities
to rehabilitation services for
uplifting their overall well-
being, inclusion and
participation.
• Desirable outcome :
– Persons with Disabilities receive individualized assessments and are involved in
the decision making for interventions provided in rehabilitation.
– Persons with Disabilities and their family members are aware about the role and
purpose of rehabilitation and receive accurate information about the services
available within the health sector.
– Persons with Disabilities are referred to specialized rehabilitation services and
are provided with follow-up to ensure that these services are received and meet
their needs.
– Basic rehabilitation services are available at the community level.
– All the required materials are available for CBR personnel, Persons with
Disabilities and families to support rehabilitation activities.
– Appropriate training, education and support are received to enable them to
undertake rehabilitation activities.
5. Assistive Devices

• Goal: provide access to Persons with

Disabilities for appropriate assistive
devices that are of good quality and
enable them to participate in social and
personnel life.
• Desirable outcome:
– CBR personnel have proper knowledge about the types of assistive devices
available, functionality and suitability according to the disability and referral
mechanisms for specialized devices.
– Persons with Disabilities and their families are aware about the types and
function of the assistive devices and make informed decisions to access and use
them.
– Persons with Disabilities and their families are provided with training,
education and follow-up to make sure that they use and care for their assistive
devices appropriately.
– Local people, including Persons with Disabilities and their families, are able to
fabricate basic assistive devices and undertake simple repairs and maintenance.
– Barriers preventing access to assistive devices, such as inadequate information,
financial constraints and centralized service provision, are reduced.
– Environmental factors are addressed to enable individuals to use their assistive
devices in all locations where they are needed.
 Education
• Ensures inclusive learning opportunities for people with disabilities.
1. Early Childhood Education
2. Primary
3. Secondary and higher
4. Non-formal
5. Lifelong learning
• Education starts from the birth and is broader than just school. Every
human has the right to education and Persons with Disabilities should not
be excluded from this.

• Goal: to provide Persons with Disabilities access to education and lifelong

learning, leading to fulfillment of potential, a sense of dignity and self-
worth, and effective participation in society.
1. Early childhood education
• Early childhood is the period from
birth to eight years and early
childhood care and education is the
main seed for the inclusive society as
children with and without disability
get to play and learn together.

• Goal: all children with disabilities

have the best possible start in life and
are supported throughout their
development in inclusive learning
environments.
• Desirable outcome:
– All children have an increased chance of survival and good health.
– All the children are developed to their maximum potential in physical,
social, language and cognitive skills.
– Inclusive and welcoming environment for all children to access formal
and non-formal early childhood education.
– Children with disabilities and the people who assist them are part of the
family and community and have appropriate support.
– Children learn to play together, accept the differences between them and
help each other.
– The impact of impairments is reduced and compensated for.
– Children with disabilities make a smooth transition to primary schooling
together with their peers.
2. Primary education

• usually begins from age of six or seven

years old and continues into the early
teens.
• Achieving universal primary education is
the second of the Millennium
Development Goals.
• Goal: to create a welcoming, inclusive
primary education system in local schools
within the community.
• Desirable outcome:
– The whole community is working to develop inclusive primary education.
– Families create supportive and positive environment for inclusive primary education.
– Every children with disability complete a quality primary education.
– All the assistive devices, interventions and other necessary assistance are provided so that children with
disability can participate in inclusive education.
– Proper assessment and identification of issues related to access within school environment is done and
those are addressed.
– Teachers who educate children with disabilities are confident and are made to feel supported.
– Every activity should be child-focused and inclusive like: Curricula, examination and assessment
systems, teaching approaches and extracurricular activities (e.g. sports, music, clubs).
– Appropriate Local and specialist resources for education are provided and they are fully and
appropriately utilized.
– Disabled children from poor families attend primary school.
– To ensure national policies promote inclusive primary education, needed partnerships are created with
stakeholders and proper advocacy at all level is also done.
3. Secondary and Higher Education
• Goal: facilitate the inclusive
education, increase participation of
disabled children and work with the
local authorities and school to create
accessible environment and flexible
curriculum.
• Desirable outcome:
– Increased enrolment, retention and completion in secondary and higher education by
students with disabilities.
– Government grants, scholarships and other sources of funding are provided to students
with disabilities and parents and communities have knowledge and skills to access
these kind of support.
– Communities support lobbying groups and campaigns for equal access to education.
– Families and communities encourage their children, including children with
disabilities, to pursue secondary and higher education.
– Secondary and higher education programmes are accessible and inclusive in terms of
environment, teaching methods, curricula, extracurricular activities (e.g. sports,
recreation, music) and assessment and examination systems.
– Secondary schools learn about diversity and inclusion from the experiences of people
with disabilities, and develop skills needed for an inclusive society.
– Specialist resources and support are used correctly to enhance the inclusion of students
with disabilities.
– Transitions between secondary/higher education programmes and into adult life are
well supported and career guidance is accessible and inclusive.
4. Non-formal Education

• Goal: to develop knowledge and skill in

PWDs and improve their quality of
life(QOL).
• PWDs should get access to educational
opportunities that suit their own need
and interest in inclusive setting.
• Desirable outcome:
– PWDs participate in non-formal education programmes and learn skills
that contribute to their better living conditions.
– PWDs actively participate in planning and execution of non-formal
education.
– PWDs, family members, disabled people’s organizations and parents’
associations play vital role in decision-making and implementing non-
formal education programmes.
– Home-based learning is available either as a supplement to formal
schooling, or in preparation for formal schooling, or as an alternative to
formal schooling.
– Students with disabilities and non-disabled students interact together and
develop friendships which help to strengthen the social cohesion.
5. Lifelong Learning
• Goal: to provide access to
PWDs for lifelong learning
opportunities and variety of
learning experiences.

• The opportunity of lifelong

learning will help to prevent
social exclusion,
marginalization and
unemployment of PWDs.
• Desirable outcome:
– Favorable environment is created during formal schooling to Youth with disabilities
for learning skills and are helped in their transition to the world of work through
vocational and careers guidance and peer counselling services.
– Adults with disabilities have access to appropriate, flexible and effective learning
opportunities throughout life, for example adult literacy through open schools and
higher education through distance learning.
– Individuals and groups who have special needs, such as youth and adults with
significant and multiple impairments as well as their caregivers and family members,
have access to ongoing learning opportunities.
– Education related to life skills and survival needs including knowledge about
reproductive health, sexuality and Human Immunodeficiency Virus (HIV) are
provided to youths and adults with disabilities.
– Every educational institute in community promote social inclusion of youth and adults
with disabilities by providing lifelong opportunities.
 Livelihood
• Promotes economic independence and employment opportunities.
1. Skills Development
2. Self-Employment
3. Wage Employment
4. Financial Services
5. Social Protection
• The goal of CBR program pointed to livelihood is that PWDs gain a
livelihood, can easily access social protection measures and are able to
contribute to their families and communities economically.
1. Skills Development

• PWDS lack the skills due to

lack of support form family,
community and lack of access
to basic education needed for
the skill training.
• Goal: to provide proper
knowledge, attitudes and skills
to PWDs on basis of their
need.
• Desirable outcome:
– Various training opportunities, skills and decent work are provided to
Youth and adults with disabilities so that they have access to income.
– There is discrimination free environment for creating opportunities to
PWDs of both gender.
– Mainstream providers of vocational and skills training have policies and
practices that makes sure that PWDs have access to the training provided.
– PWDs have access to support services – vocational guidance, placement
services, assistive devices and adapted equipment.
– Advanced skills development opportunities that will help to grow PWDs
in their work is provided.
2. Self-employment
• Self-employment program will
allow PWDs to improve their
livelihood, improve their standard
of living and contribute to the
well-being of their families and
communities.

• The CBR program encourages

and supports self employment
through enhancing access to skills
development as well as financial
and material resources.
• Desirable outcome:
– PWDs choose their own economic activities to do either in group or individually to earn
income.
– The policies and practices about training and assistance made by mainstream government
and non governmental small-enterprise development programmes include provision for
PWDs.
– People with disabilities have access to support services – basic business skills training,
business development and financial services – to initiate or expand entrepreneurial
activities.
– Access to business skills development opportunities is provided to PWDs so that they can
progress in their economic activities.
– PWDs are recognized as successful entrepreneurs and productive, contributing members of
the community.
– PWDs promote economic activities and become positive-role model and influencer which
contribute to the development of inclusive communities.
– Especially women with disability have control over the money they earn.
– Successful entrepreneurs with disabilities act as trainers of other PWDs.
3. Wage Employment

• Wage employment provide equal

access to earning for PWDs.

• CBR program help PWDs to have

access to services that lead to wage
employment, access and retain wage
employment.
• Desirable outcome:
– PWDs earn through wage employment in the formal or informal
economy.
– Inclusive and accessible environment is created at work when employers
hire and retain PWDs.
– Coworkers and management develop greater understanding of disability
issues and positive attitudes.
– PWDs are included in mainstream job services both in private and public
sectors.
– Wage employment help PWDs to increase their self-esteem, personal
security and status within their family and community.
– Through wage employment, PWDs contribute to community life and the
economy.
4. Financial Services

• Financial services provided to

PWDs and their families
support the development of
their economic and other
activities which will
ultimately improve their
standard of living.
• CBR program identify,
facilitate and promote access
of PWDs to financial
services.
• Desirable outcome:
– Based on poverty criteria, government or private institutions provide
grants, loans and other financial assistance and PWDs have access to
those facilities.
– The financial services provided to PWDs enable them to meet their needs
and start small business to earn an income.
– PWDs, especially women are capable of managing and have control over
the financial resources.
– PWDs are included when financial service providers adapt their rules,
services and environment.
5. Social Protection

• Goal: to allow PWDS who are out of

work, who are unable to work or
who have difficulty maintaining their
livelihood to enjoy a minimum
standard of living through social
protection measures.
• The CBR program facilitates the
access of PWDs to mainstream or
specific social benefits and promote
the provision of social protection
measures.
• Desirable outcome:
– Social security measures are provided against loss of income through old
age, sickness or disability to PWDs as other citizens without any
discrimination.
– Social protection measures are available to all PWDs who are out of
work, earn too little for a decent living or have difficulty working.
– Existing social services providers are sensitized and aware of the specific
difficulties faced by PWDs and adapt their service provision accordingly.
– Social security providers develop partnerships with PWDs, through their
representative organizations and service providers, to adapt practices to
their specific needs.
 Social
• Enhances community participation and social inclusion.
1. Personal Assistance
2. Relationships & Family
3. Culture & Arts
4. Recreation & Sports
5. Justice & Legal Protection
• PWDs face many barriers and less opportunities while participating in social
activities.

• Goal: PWDs have meaningful social roles and responsibilities in community

and family, and they are viewed as equal members of society.
1. Personal Assistance

• Goal: to enable PWDs to lead

active and fulfilling lives by
providing access to personal
assistance according to their needs.

• Proper personal assistance help

PWDs to live with self-
determination and dignity.
• Desirable outcome:
– To ensure quality of personal assistance options in the local community, CBR
programmes and disabled people's organizations work together.
– PWDs have individual support plans in place.
– PWDs have proper training and access to manage their personal assistance needs.
– Training is available for both informal (family and friends) and formal(social
services, private employees) personal assistants.
– Those who provide informal personal assistance are supported.
– Family and community are trained and all the mechanisms are ready and in place
to respond to crisis situations and prevent PWDs being sent into institutional care.
– Local communities support and provide community-based personal assistance
options for PWDs.
2. Relationships, Marriage and Family

• Goal: to make PWDs realize their positions

and roles within their families and
communities to create the fulfilling
relationships with members of their families
and communities.
• Desirable outcome:
– People in the community have knowledge, are aware and accept that
PWDs can have meaningful relationships, marry and have children.
– Appropriate services and programmes to support parenting roles are
accessible to parents with disabilities and parents of PWDs.
– Families encourage and support their members with disabilities to
socialize and develop relationships outside the home.
– All the relevant stakeholders work together to address the issue of
protection for PWDs and PWDs are protected against violence.
– PWDs who have limited social networks are well supported in their
communities.
3. Culture and Arts

• Goal: to enable PWDs to contribute

and participate in the cultural and
artistic lives of the family and
community they belong.
• Desirable outcome:
– Through culture and art, stigma and discrimination that is present in
community towards disability is challenged and addressed.
– PWDs and their family members actively participate in various cultural
and arts events and activities.
– Mainstream organizations and groups support the inclusion of PWDs in
their cultural and artistic programmes and activities.
– PWDs have access to mainstream cultural/arts media and venues.
– Spiritual and religious leaders and groups include PWDs in their
activities.
 4. Recreation, Leisure and Sports
• Active participation of PWDs in recreation,
leisure and sports improve their health and
well-being of individuals, contribute to the
empowerment of individuals and promote

• Goal: promote and support increased

participation of PWDs in recreation, leisure
and sports activities; and provide support to
mainstream organizations and programmes
to enable them to strengthen their capacity
by offering appropriate and accessible
recreation, leisure and sports activities.
• Desirable outcome:
– PWDs actively participate in available recreation, leisure and sports
programmes in the local community.
– PWDs are also included in recreation, leisure and sports programmes organized
by local, national and international authorities and associations.
– The right and ability of PWDs to participate in recreation, leisure and sports
activities are well recognized and promoted by families, teachers and
community members.
– People both with and without disabilities are involved together in recreation,
leisure and sports activities.
– The venue for recreation, leisure and sports activities are accessible to PWDs.
– Equipment used for recreation, leisure and sports is adapted where needed to
accommodate the needs of PWDs.
– Recreational, leisure and sports programmes and activities are developed
specifically for PWDs where required.
5. Justice

• The CBR program focused on this

element make sure that PWDs
have access to justice on and equal
basis with others.
• The program promotes and
provides support to PWDs and
their family members to access
justice where they face
discrimination and exclusion.
• Desirable outcome:
– CBR programmes are able to support PWDs to access justice when needed.
– PWDs have proper knowledge and aware about their right and choices and
process needed for accessing justice.
– Relevant stakeholders in the justice sector are sensitive to the needs of
PWDs and follow non-discriminatory practices.
– PWDs are able to access informal mechanisms (can be accessed through
religious and development organizations, village leaders, tribal leaders,
social workers, educational and health professionals) of justice when their
rights are violated.
– PWDs are able to access formal mechanisms (can be accessed through court)
of justice when their rights are violated
 Empowerment
• Strengthens self-advocacy and rights-based approaches.
1. Advocacy & Communication
2. Community Mobilization
3. Political Participation
4. Self-Help Groups
5. Disability Organizations (
• Empowerment is the final component of CBR matrix and is different than
other component.

• Other four components focus on the key development sectors while this
component focuses on the importance of empowering PWDs, their family
members and communities to facilitate the mainstreaming of disability
across each sector and to ensure that everybody is able to access their rights
and entitlements.
1. Advocacy and Communication

• Self advocacy and communication is a

vital element for PWDs.
• Goal: to enable PWDs to speak out for
themselves. CBR program help PWDs to
develop advocacy and communication
skills and help create favorable
environment for opportunities to allow
them to make decisions and express their
needs and desires in effective way.
• Desirable outcome:
– Improved access to information and communication resources are
available to PWDs and their families.
– Barriers in communication faced by PWDs are reduced and/or eliminated.
– PWDs and their families represent themselves in their respective
communities.
– CBR personnel are effective communicators and share information with
all stakeholders including those who have communication difficulties.
 2. Community Mobilization
• When different people from different parts
of the community share a common goal
and actively participate in specific
program, a lot can be achieved.
• Community mobilization is the process of
bringing together as many stakeholders as
possible to achieve the goal of the
program.
• Goal: to empower local community
members to remove the challenges for
PWDs and their families, and play an
active role in creating inclusive
community.
• Desirable outcome:
– Communities are aware about the needs, and motivated to improve the
quality of life of PWDs and their family members.
– The barriers faced by PWDs and their families are reduced or removed.
– Communities are knowledgeable about CBR and how community
resources can be used to develop and sustain CBR programmes.
– Communities participate in planning, implementing and managing CBR
programmes.
 3. Political Participation
• Goal: to enable PWDs to participate in
political and public life on an equal basis
with others.

• CBR program ensures that PWDs and their

families have adequate knowledge,
information, skills and information about
political participation and the opportunities
for participation are also accessible to them.

• also works to make issues of disability

visible so that PWDs are integrated into
political decision-making and are at the
center of development policies and
programmes.
• Desirable outcome:
– CBR personnel are aware about the political system.
– PWDs and their family members are aware about the political
participation.
– Governments and civil society are aware of disability issues and the rights
of PWDs and their families to participate in political processes.
– Challenges faced by PWDs in political processes are minimized or
removed.
4. Self-help Groups

• CBR program focused on this element

provides assistance and support to
PWDs and their families to form new
self-help groups or support the existing
ones.
• The main goal of creating self-help
groups is that PWDs and their family
members are able to resolve common
problems in group, improve their
individual strength and quality of life.
• Desirable outcome:
– There are self-help groups in local communities for PWDs and their
family members.
– Self-help group members develop knowledge and skills that help them to
become contributors in their families and communities.
– Self-help groups that are available to other member of the community are
also accessible to PWDs and their family members.
– Self-help groups promote CBR, and members become involved in the
planning and implementation of CBR programmes.
– Self-help groups join together to form federations and become self-
sufficient.
4. Disabled Person's Organizations

• Both CBR programmes and disabled

person's organizations focuses on
ensuring the implementation of the
Convention on the Rights of PWDs
and community-based inclusive
development.
• The role of CBR is to work in
partnership with disabled people’s
organizations where they exist, and
where they do not exist, to provide
assistance when requested to support
their formation.
• Desirable outcome:
– CBR programmes and disabled people’s organizations work together to
plan, implement and monitor new or existing CBR programmes.
– Disabled person’s organizations support CBR programmes to become
more representative and inclusive of PWDs.
– Disabled person’s organizations are motivated to develop and implement
CBR programmes in communities where they do not exist.
 Case Report: Application of the CBR Matrix in
Rehabilitation of a Person with Spinal Cord Injury
Demographic Details
• Name: Mr. Ramesh Thapa
• Age: 32 years
• Gender: Male
• Address: Rural village, Kaski District, Nepal
• Diagnosis: Traumatic spinal cord injury (T12 level) following a fall from a tree
• Date of Injury: January 2024
• Referred By: Regional Hospital, Pokhara
A. Health Component
– Medical Care: Referred to a rehabilitation center in Pokhara for acute
management and initial rehab.
– Rehabilitation: Received physiotherapy for muscle strengthening,
transfer techniques, and bladder-bowel training.
– Assistive Devices: Provided with a customized wheelchair and pressure-
relieving cushions.
– Follow-up: Monthly visits by a physiotherapist and community health
volunteer.
B. Education Component
– Functional Literacy: Joined an adult education program to improve
reading and writing skills.
– Awareness Training: Educated on personal care, pressure sore
prevention, and basic rights.
– Family Education: Family members were trained on caregiving
techniques and support strategies.
C. Livelihood Component
– Skills Training: Enrolled in a vocational training program (mobile repair)
organized by a local NGO.
– Microcredit Support: Received a small loan to start a home-based
mobile repair shop.
– Income Generation: Currently earning a stable income and contributing
to household expenses.
D. Social Component
– Inclusion in Community Events: Participated in local festivals and
social gatherings with the help of local youth groups.
– Peer Support: Joined a local disabled persons’ organization (DPO) and
attends monthly meetings.
– Accessibility: Ramp constructed at his home with local government
support to improve mobility.
E. Empowerment Component
– Self-Advocacy: Received training in leadership and disability rights
through DPO workshops.
– Decision Making: Actively involved in family decisions and community
meetings.
– Representation: Selected as a community focal person for raising
awareness about disability inclusion.
References
• Community-based rehabilitation: CBR guidelines, 2010