Who Carries the Convention to the Village? CBR After the Quiet Retreat of the International Agencies

In the very week the world celebrated twenty years of the Convention on the Rights of Persons with Disabilities, I kept returning to a paradox few seem to notice: the approach that carried this Convention's principles into millions of homes in villages and low resource communities Community Based Rehabilitation has for years been living through a quiet retreat in the stewardship of the international agencies that helped build it. The text was celebrated in New York, while the mechanism that delivers it to people is left to fend for itself.

For those who do not know the story: CBR was not born in a conference hall. It emerged from a practical question that confronted the world after the Alma Ata Declaration on primary health care in 1978: how do rehabilitation services reach millions of persons with disabilities in countries that do not have and will not soon have enough specialized institutions?

The answer was an idea both simple and revolutionary: the community itself can be the platform for rehabilitation its families, its workers, its schools, its mosques and churches, its markets.

The approach matured over decades: a joint position paper by WHO, ILO and UNESCO in 2004; then the global CBR Guidelines in 2010, with the now-famous matrix of five components health, education, livelihood, social life and empowerment which gave the field a common language and a multisectoral framework matching the Convention's spirit article by article. The concept itself then evolved into Community Based Inclusive Development, underlining that the goal is not a service delivered to a group, but a community rebuilt to include everyone.

I lived this evolution from the inside: in the villages of Upper Egypt, through Kayan's programmes, and across the networks of the African continent. I saw with my own eyes what reports cannot convey: a family stepping out of isolation because a community worker knocked on their door; a child entering school because someone connected his father to the headteacher; a young man opening a small business because a local savings group believed in him before any bank did.

No official statement ever announced that UN agencies were abandoning Community Based Rehabilitation. What happened was quieter, and more consequential: institutional attention at WHO shifted toward the Rehabilitation 2030 initiative, launched in 2017, focused on integrating rehabilitation into health systems; technical and financial support earmarked for the community approach contracted year after year; and the term gradually disappeared from the major international documents and strategies to the point that the Convention's 20th anniversary passed without the approach finding any mention in its discourse.

To be fair: the focus on health systems is necessary and important, and Rehabilitation 2030 has filled a real gap in the place of rehabilitation within universal health coverage. But the community approach was never merely a health programme. It was a multisectoral development framework spanning education, livelihood, participation and empowerment. When international attention narrowed to the health component, the wider framework lost its institutional steward and four fifths of the matrix were left without an international address to claim them.

I write this without bitterness and without accusation; international organizations rearrange their priorities for reasons of their own, some of them sound. But it is our duty to call what happened by its name: a global leadership vacuum emerged, and vacuums have a price paid not by those who left, but by those who cannot leave.

High income countries barely feel this vacuum; they have delivery systems in place comprehensive insurance, funded social services, capable local government. In our countries, where the great majority of the world's persons with disabilities live, delivery systems are fragile or absent, and the community approach was the feasible alternative infrastructure: the only tested way of bringing the five entitlements health, education, livelihood, participation, empowerment to a village that nothing else reaches.

Without a community delivery mechanism, the Convention's rights become, in practice, an urban privilege: enjoyed by those who live near services and can afford to reach them, denied to the residents of villages and peripheries that is, to the majority. This, to my mind, is the closest explanation of the paradox I discussed in my previous article: laws in over 90 per cent of countries, and nearly all development indicators failing. The text exists; the carrier is missing.

Who Fills the Vacuum Today?

The honest answer: those who do not have the luxury of withdrawal. The regional networks and I have the honour of chairing the International Advisory Board of the CBR Africa Network (CAN), which works to connect practitioners across the continent and to build an African reference point for knowledge in this field alongside the CBR Global Network (CGN) linking the regions, national networks, organizations of persons with disabilities, a number of development partners who have stayed faithful to the approach, and thousands of community workers who keep walking to the last house in the village on shrinking resources.

Nor has knowledge stopped accumulating in the absence of international stewardship. Recent field research in the inclusive development sector including studies published this year by European partners working across the continent confirms what practice has long taught us: sustainability is not a closing phase added at the end of a project, but a design decision taken on day one; and the factor that separates a programme that lasts from one that evaporates is its institutionalization within a lead government ministry, with clear authority and a domestic budget. That is a finding which deserves to travel from the field to the policy table.

First, renewed international recognition of community based inclusive development as an endorsed mechanism for implementing the Convention and the SDGs and the return of its name to documents, resolutions and conferences. A term that disappears from the documents soon disappears from the budgets.

Second, integration into national systems: national development plans and budgets must adopt the community approach, rather than leaving it to scattered short term projects that die when their funding ends. Experience is unambiguous: what does not enter the government system does not last.

Third, investment in the community worker: accredited training, fair pay, professional recognition, and a career path. These workers are the real infrastructure of the last mile of rights and most still serve as volunteers or on wages unworthy of their impact.

Fourth, networks moving from exchange to influence: regional and global networks must raise their voice in policy, not only in peer learning. The third CBR/CBID World Congress, expected in 2027, is an opportunity that must not be missed to put this agenda back on the international table this time from the Global South, and under its leadership.

International organizations are entitled to change their priorities; the village is not able to wait. And when the big stewards stepped back, the approach did not die because it never belonged to them. It belonged to the communities that found in it their road to dignity, and to the practitioners who carried it before the guidelines and after them.

Our responsibility we who inherited this banner in Egypt, in Africa and across the Global South is not merely to guard it, but to advance it.