The SAKSHAM Model: A Rights-Based, Standardized Community-Based Rehabilitation Framework for Rural India
Year: 2026
Type: article
Abstract: Background: Community-Based Rehabilitation (CBR) has evolved from a primary health care strategy under theDeclaration of Alma-Ata into a comprehensive rights-based development approach endorsed within the WHObiopsychosocial framework of the International Classification of Functioning, Disability and Health (ICF). Indiais home to 27.9 million persons with disabilities (PWDs), 76% of whom reside in rural areas where disability iscompounded by poverty, agricultural livelihood dependence, gender inequality, caste-based discrimination and acritical shortage of specialist rehabilitation personnel (approximately 30,000 physiotherapists for 1.4 billion people).This paper describes the SAKSHAM Model, a standardized CBR framework designed to operationalize WHOCBR guidelines within India’s existing government health, education, livelihood and social-welfare infrastructure.Methods: A narrative synthesis of WHO CBR guidance, the ICF framework, national legislation (Rights ofPersons with Disabilities Act 2016, RTE Act 2009), and operational guidelines of major Indian governmentschemes (National Health Mission, Samagra Shiksha, Deendayal Disabled Rehabilitation Scheme, MGNREGAand Ayushman Arogya Mandirs) was undertaken to design a five-component convergence model, a task-shiftedcommunity health workforce structure, and a life-course battery of 22 validated assessment instruments forstandardized implementation and monitoring.Results: The SAKSHAM Model integrates Health, Education, Livelihood, Social Inclusion and Empowermentcomponents delivered through a three-tier task-shifted workforce of 2.84 lakh ASHAs, 0.12 million ANMs anddedicated Community Rehabilitation Workers, supervised by district physiotherapists and anchored at 1,73,881Ayushman Arogya Mandirs. A three-tiered output-outcome-impact indicator system, standardized life-coursescreening tools (WHODAS 2.0, Modified Ashworth Scale, Functional Independence Measure, WHOQOL-BREF,and allied instruments), and convergent financing across five national schemes provide a replicable, low-cost(approximately Rs. 12-20 crore per million rural population annually) implementation pathway. Conclusions: The SAKSHAM Model offers public health practitioners, district administrators and policymakersa constitutionally grounded, standardized conceptual framework that repositions disability from an individualmedical problem to a multi-sectoral social-determinants issue, addressable through convergent use of existinggovernment infrastructure rather than parallel service creation. As the model has not yet been field-tested, itsfeasibility, acceptability, cost, workforce requirements and effectiveness should be evaluated through pilotimplementation before wider state or national scale-up is recommended.
DOI: 10.37506/wq5n7316
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: hybrid
OpenAlex ID: W7213901142