Giacaman R
Institute of Community and Public Health, Birzeit University, Palestine.
Disabil Rehabil. 2001 Sep 20;23(14):639-44. doi: 10.1080/09638280110036544.
It has been widely argued that community based programmes offer considerable advantages to the classical institutional forms of health and rehabilitation services delivery. With about 10 years of experience in operating community based rehabilitation projects (CBR) for the disabled, the Palestinian experience points to potentially serious problems relating to the conception and operationalization of such programmes in real life situations.
Of importance is the issue of the impact of communal care on the already burdened lives of women, especially when such care is expected to be voluntary in nature. Caretaking in the Palestinian context, especially of the disabled, elderly and the sick, is a pre-defined sex linked role dictated by a patriarchal society and system of policy making that excludes women from economic and social life. The voluntary care aspect entailed in the CBR conception and practice, can and does contribute further to the exclusion of women not only from the labour force, but from most other aspects of life as well. This represents an apparent contradiction between the needs of two excluded groups, the disabled and women. The other problematic entailed in the communal model of caring for the disabled is the strategic and operational bias focusing on community, to the exclusion of the notion of social rights of all citizens, and the role and duty of state structures in the fulfilment of the disabled basic needs. Such an approach can only relegate the disabled rights back to their original place as charity. On the other hand, when CBR projects are operated holistically, in the context of social movements existing within power relation and with a broader democratic agenda engaging different groups-including a disability movement-as is currently taking place in Palestine, CBR projects can also turn into a mobilizing force for the social rights of all excluded groups.
Thus the question is not merely one of governmental involvement as opposed to the involvement of non-governmental organizations and charitable societies in community based projects. Rather, it is a question of the right to a decent life for all, in dignity and security, that citizenship and statehood promise, but have yet to deliver in many developing countries, especially in Palestine.
人们普遍认为，基于社区的项目相对于传统的机构形式的健康和康复服务提供方式具有相当大的优势。在为残疾人开展基于社区的康复项目（CBR）约10年的经验基础上，巴勒斯坦的经验指出了此类项目在现实生活中的构想和实施可能存在的严重问题。
重要的是社区照料对本已负担沉重的妇女生活的影响问题，尤其是当这种照料预计本质上是自愿的时候。在巴勒斯坦背景下，照料工作，尤其是对残疾人、老年人和病人的照料，是由父权制社会和决策体系预先确定的与性别相关的角色，这种体系将妇女排除在经济和社会生活之外。CBR构想和实践中所涉及的自愿照料方面，能够而且确实进一步导致妇女不仅被排除在劳动力之外，而且被排除在生活的大多数其他方面之外。这体现了两个被排斥群体，即残疾人和妇女的需求之间的明显矛盾。照料残疾人的社区模式中存在的另一个问题是，战略和操作上偏向于社区，从而排除了所有公民的社会权利概念，以及国家机构在满足残疾人基本需求方面的作用和责任。这种做法只会将残疾人权利退回到其作为慈善的原始地位。另一方面，当CBR项目在权力关系中存在的社会运动背景下，并在一个涉及不同群体（包括残疾运动）的更广泛民主议程的背景下全面开展时，就像目前在巴勒斯坦正在发生的那样，CBR项目也可以成为所有被排斥群体社会权利的动员力量。
因此，问题不仅仅是政府参与相对于非政府组织和慈善团体参与基于社区的项目的问题。相反，这是一个关乎所有人体面生活的权利的问题，即享有公民身份和国家地位所承诺但在许多发展中国家，尤其是在巴勒斯坦尚未实现的尊严和安全的权利。
