An update on community based rehabilitation for leprosy practitioners.

During recent years we have seen quite a number of developments in the field of leprosyrelated disability. Some organisations and programmes have increasingly paid attention to individual physical needs of people affected by leprosy through, for example, prevention of disability (POD) activities included the formation of self-care groups. We see also in some parts of the world that self-care groups gradually evolve into self-help groups with a stronger focus on advocacy and socio-economic rehabilitation. Increasingly we notice developments into multi-disability self-help groups such as the large number of self-help groups that can be found these days in India. Such self-help groups may even form federations and coalitions and become, in fact, disabled people’s organisations (DPO); some specifically focusing on people affected by leprosy while others become multi-disability DPOs, which include people affected by leprosy. The ILEP Guidelines for SER were an expression of new thinking and new direction. The more recent ILEP-WHO Guidelines on CBR provide an even broader framework of thinking and focus on integration of people with a disability and people affected by leprosy in society with equal rights and participation. Besides a growing awareness among leprosy practitioners that they have an important role to play regarding the rehabilitation of people affected by leprosy (physical, social, economical as well as psychological), it is encouraging to note that within mainstream disability development more attention is given to the position of people affected by leprosy as well. The year 2008 will mark the launch of a new set of general guidelines for the development and management of Community Based Rehabilitation (CBR). The Disability and Rehabilitation (DAR) unit of the World Health Organization has been working for quite some time with over 150 authors on these new CBR Guidelines. The Guidelines have been field-tested in the second half of 2007 in 25 countries and on the 3rd of December 2008 – International Disability Day – the Guidelines become reality. These Guidelines form the tangible outcome of the International CBR review that took place during 2003 in Helsinki. However, there is another outcome that is certainly of equal importance: the final transformation of CBR from a service delivery model into an inclusive development strategy. For some professionals this still remains a controversial development, while for others it is a logical step forward and a recognition for the work they have been doing for a long time: working in the struggle for human rights and more specifically the rights of disabled people. While in essence the struggle for equal rights forms the basis of thinking for a growing number of disabled people with regard to rehabilitation, there is also a counter side to it: the so much needed services (e.g. medical or social services) may never be provided as long as policies and guidelines are not put in place and especially not put into practice. Legislation and (new inclusive) policies, though of great importance, are themselves no guarantee for accessible and appropriate services. Similarly guidelines may easily end up on the shelves of Lepr Rev (2008) 79, 1–3