CBR programmes can gather information about existing prevention activities in their communities and work with prevention programmes to include people with disabilities, thus ensuring greater coverage.

CBR can:

• ensure that people with disabilities and their families are aware of the types of prevention activities available in their communities;
• ensure that health personnel are aware of the needs of people with disabilities;
• ensure that information about prevention activities is available in appropriate formats and in a variety of locations close to where people live;
• determine whether locations where prevention activities take place are physically accessible and, if not, provide practical ideas and solutions to make them accessible;
• determine whether prevention services can be provided in alternative locations, e.g. home environments, when access is difficult.

Healthy behaviours such as avoiding smoking and drinking alcohol, eating healthily, exercising regularly and wearing condoms during sex can reduce the risk of health problems.

Prevention programmes often use health promotion strategies, such as awareness campaigns, to communicate prevention messages in communities and education for individuals, to encourage healthy behaviour.

See the Health promotion element for suggested activities to promote good health behaviours.

In each community, immunization programmes should be made available for specific diseases and for high-risk groups, including:

• poliomyelitis
• diphtheria
• tetanus and measles vaccinations for infants and young children
• tetanus vaccination for pregnant women.

CBR programmes can:

• become actively involved in awareness campaigns to promote immunization for all community members, including people with disabilities;
• contact primary health care workers to educate them about the importance of immunization for people with disabilities, especially children with disabilities;
• work with primary health care services to ensure that people with disabilities and their family members are able to access vaccination programmes in their communities;
• ensure that people receiving support and assistance from CBR have received the recommended immunizations;
• provide information about the location of safe and reputable services for people who have not received recommended immunizations, and support them to access these services as necessary;
• work with primary health care services to make alternative arrangements for people who are unable to access vaccination programmes.

Poor nutrition (malnutrition) usually results from not getting enough to eat and poor eating habits, and is a common cause of health problems. Ensuring adequate food and nutrition in communities is the responsibility of various sectors, with which CBR needs to collaborate. 

Suggested activities in the health sector for CBR include the following.

• Ensure that CBR personnel are able to identify people with signs of malnutrition and provide referrals, when needed, to health workers for proper assessment and management.

• Encourage the use of iron-rich and vitamin-rich foods that are locally available, such as spinach, drumstick leaves, whole grains and papaya fruit.
• Demonstrate low-cost, nutritious recipes to encourage people to eat nutritious foods.
• Ensure that children with disabilities get sufficient and appropriate food to eat.
• Identify people with disabilities who have feeding difficulties, such as  children with cerebral palsy who have chewing and swallowing problems, and provide referrals to speech and language therapists where possible.
• Provide simple suggestions for families about ways to assist people with disabilities to eat and drink safely and more easily.
• Identify nutrition initiatives available in the community and ensure that people with disabilities can access these programmes, that children with disabilities are actively included in programmes that monitor growth, provide micronutrients and supplementary food, promote breastfeeding and encourage pregnant women to attend antenatal care to obtain iron and folic acid supplements.

Learn how a programme in India addressed malnutrition by providing nutritional supplements to young children.

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The Sanjivini Trust in Bangalore, India, has been working with women and children for over a decade. One of its main interventions has been to address the issue of malnutrition in children, especially those below five years of age. 

The Trust provides a nutritional supplement in the form of an energy-protein-rich powder to all malnourished children once a month. Volunteers are trained to prepare the supplement and distribute it to needy children. Mothers are given nutrition education and shown how to prepare low-cost nutritious meals using locally-available grains and vegetables. 

Sanjivini also works in collaboration with other organizations that provide rehabilitation for children with disabilities, by providing them the nutritional supplement. Children with special needs such as feeding problems have benefited enormously from using the supplement.

Afreen is nine years old and has cerebral palsy. She lives with her parents and two sisters in Illyasnagar slum, Bangalore. Her family migrated to Bangalore when Afreen was six years old. Because she was fed only on liquid foods, she was malnourished and bedridden, poorly developed and had frequent diarrhoea and seizures. 

A CBR worker was initially unable to give Afreen any form of therapy due to her condition, so she was given the nutritional supplement and, over a period of one year, Afreen’s health gradually improved, and she developed strength. Afreen now goes to the coaching centre for therapy and stimulation. Her family is overjoyed at her improvement and her mother is now able to introduce her to other foods.

Antenatal care, skilled care during delivery and postnatal care reduce the risk of mothers and babies developing health conditions and/or impairments that may lead to disability.

CBR programmes should:

• identify maternal health services available in the community, such as antenatal care;
• provide all women with information about maternal health services and encourage them to access these;
• provide additional support for women with disabilities when access to maternal health services might be difficult, e.g. providing advocacy where discrimination exists in the health-care system;
• refer women and their families for genetic counselling when they have specific questions or concerns related to current or future pregnancies;
• advise health services about access issues for pregnant women with disabilities, e.g. providing suggestions about appropriate communication methods and advice on how to make hospitals and delivery rooms accessible;
• find out whether there are training programmes for traditional birth attendants operating in the local communities, and ensure that such programmes include information on disability and early recognition of impairments;
• encourage families to register children with disabilities with the local authorities at birth.

Water and sanitation measures contribute to improving healthy living and minimizing disability.  To help ensure that the needs of people with disabilities are considered, CBR personnel can:

• talk to people with disabilities and their family members about the barriers they face when accessing and using water and sanitation facilities – for example, people with disabilities may be unable to access water sources because they live too far away or the route to the water source is not accessible;
• make local authorities and water and sanitation organizations aware of these barriers;

• provide suggestions and ideas for ways to overcome the barriers in partnership with people with disabilities and their family members;
• lobby and work with local authorities to adapt existing facilities and build new facilities, for example by installing raised toilet seats and handrails to provide support for people unable to use a squat latrine;
• encourage community members to support and assist people with disabilities where needed, e.g. by encouraging neighbours to accompany a person with a disability when fetching water.

Many disabilities are caused by accidents at home, at work or in the community. Often adults and children with disabilities are also at higher risk of injury. CBR personnel can play a role in injury prevention in their communities by taking the following actions.

• Identify the major causes of injury in the home and community, such as burns, drowning or road traffic crashes, and the groups that are most at risk.
• Create awareness in the community about the common causes of injuries and how to prevent them.
• Work with local authorities and community groups to take action to reduce the occurrence of injuries in the home and community.
• Provide suggestions for families about how to prevent injuries in the home, such as watching children when they are near water or open fires, keeping poisons locked away and out of reach of children, and keeping children away from balconies, roof edges and stairs.
• Provide education for employers and workers on the prevention of workplace injuries – for example, by wearing appropriate safety equipment, such as shoes, helmets, gloves or earplugs, on construction sites.
• Provide education for schoolchildren about road safety, including how to cross roads safely, wearing seatbelts in motor vehicles and wearing helmets when riding bicycles and motorcycles.

People of all ages with disabilities are at risk of secondary conditions. CBR programmes can promote primary prevention strategies to reduce the likelihood that people with disabilities will develop these conditions. It is suggested that CBR programmes should:

• ensure that people with disabilities and their family members are aware and knowledgeable about the secondary conditions commonly associated with their disabilities – for example, people with spinal cord injuries or spina bifida should be aware that they are at high risk of developing urinary tract infections;
• assist people with disabilities and their families to identify health strategies that will help prevent secondary conditions – such as adopting a healthier lifestyle, having regular health check-ups and maintaining good hygiene;
• ensure that any assistive devices provided for people with disabilities do not create risks for secondary conditions.