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Evidence for the effectiveness of rehabilitation-in-the-community programmes

VELEMA, Johan P
EBENSO, Bassey
FUZIKAWA, Priscila L
March 2008

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"The present literature review identified 29 reports from 22 countries in Asia, Africa and Central America reporting on the outcomes of rehabilitation-in-the-community programmes in low and middle income countries published between 1987 and 2007. Interventions included home visits by trained community workers who taught disabled persons skills to carry out activities of daily living, encouraged disabled children to go to school, helped find employment or an income generating activity, often involving vocational training and/or micro-credit. Many programmes had a component of influencing community attitudes towards disabled persons. The information collected shows that such programmes were effective in that they increased independence, mobility and communication skills of disabled persons, helped parents of disabled children to cope better and increased the number of disabled children attending schools. Economic interventions effectively increased the income of disabled persons although they rarely made them financially independent. CBR activities result in social processes that change the way community members view persons with disabilities, increase their level of acceptance and social inclusion and mobilise resources to meet their needs"
Leprosy Review, Vol 79, Issue 1

Inclusion of persons affected by leprosy in CBR

CORNIELJE, Huib
et al
March 2008

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This article presents reflections of community-based rehabilitation (CBR) professionals who attended a workshop prior to the 17th International Leprosy Congress. The professionals discussed the need to make their rehabilitation programmes, often focussed on serving the needs of persons affected by leprosy, more inclusive for other marginalised groups, in particular persons disabled through non-leprosy causes. They also reflected on the need to promote the self-organisation of people affected by leprosy and their inclusion of them also in general Disabled People’s Organisations (DPOs) either individually or through their organisations
Leprosy Review, Vol 79, Issue 1

Funding for self-employment of people with disabilities : grants, loans, revolving funds or linkage with microfinance programmes

DE KLERK, Ton
March 2008

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"In 2005, Handicap International commissioned a study on the practices of funding for self-employment activities of people with disabilities (PWD), with a special focus on access to microfinance. The overall goal of the study was to produce a framework document highlighting good practices, strategies, tools and operational methods that guarantee the efficiency and sustainability of self-employment projects for PWDs. The first phase of the study consisted of a literature review and a worldwide survey. Through this first phase the research team identified the most innovative programmes for further analysis through field visits. In the second phase field visits were conducted in Afghanistan, Bangladesh, Ethiopia, India, Kenya, Nicaragua and Uganda, while regional workshops were organised in Dhaka and Nairobi. Phase three involved consolidation and analysis of the information and finally drafting of the framework document. This paper summarises the findings and good practices as presented in the framework document, based on the results of the literature review, the survey and the field research. It is not a scientific paper, i.e. it doesn't contain a discussion of the literature reviewed or systematic reference to sources, the same as the document on which it is based, as it is primarily meant for practitioners"
Leprosy Review, Vol 79, Issue 1

Global trends in disability rehabilitation and their implications for leprosy programmes

THOMAS, Maya
THOMAS, Maliakal Joseph
March 2008

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This article explores the global trends in disability rehabilitation and the implications for leprosy programmes. It provides a brief summary the Biwako Millennium Framework of the Asia and Pacific decade to gain a better understanding of current issues and the implications for leprosy rehabilitation programmes
Leprosy Review, Vol 79, Issue 1

Skills development through community based rehabilitation (CBR) : a good practice guide

INTERNATIONAL LABOUR OFFICE (ILO)
2008

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This guide provides an overview of CBR and illustrates examples of skill development for people with disabilities through CBR programmes. Topics are divided into six chapters and case studies highlighting good practices of skills development and enhancing access to work are included throughout the guide. This guide is useful for practitioners, policy makers and programme developers who are interested in skills development for people with disabilities through CBR

Report on the consensus conference on wheelchairs for developing countries

SHELTON, Sarah
JACOBS, Norman A
Eds
2008

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This conference report assisted the development of guidelines on provision of manual wheelchairs in less-resourced settings for which training and education are key elements. It recommends the adoption of the wheelchair International Organization for Standardization (ISO) standards as a minimum. This report is useful for government and non-government policy makers, practitioners, providers and users of wheelchair services

What is the effectiveness of community based rehabilitation in improving the well-being of adults with physical disabilities in Sub-Saharan Africa?|Policy recommendations for international non-government organizations

BOGGS, Dorothy
2008

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This policy report examines the effectiveness of community based rehabilitation (CBR) in improving the well-being of people with disabilities in Sub-Saharan Africa and provides recommendations to international NGOs for improving CBR strategy
Dissertation submitted in part fulfilment of the requirements for the degree of Master of Science in Public Health at the London School of Hygiene and Tropical Medicine
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Considerations in the quest for evidence in community based rehabilitation

KUIPERS, Pim
HARKNETT, Steve
2008

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This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries. Based on the authors' experience in, and evaluation of Community Based Rehabilitation (CBR) projects and research, they provide suggestions for utilising different kinds of evidence at different levels of CBR. The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data."This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries...The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data"

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 2

Factors shaping attitudes towards physical disability and availability of rehabilitative support systems for disabled people in rural Kenya

MONK, Julie
WEE, Joy
2008

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This study examines the range of attitudes towards persons with physical disability in a rural community in western Kenya. It also evaluates the availability of services for persons with disabilities in the community. Qualitative data analysis of interview material led to the generation of a model describing the attitudes towards people with disabilities. Availability of services was explored through interview questions and document collection. Perceived cause of disability, perceived characteristics and activities of people with disabilities by the community and perceived role of society, appear to shape the attitudes towards people with disabilities in the community studied. The opinions within these categories contribute to enabling and disabling features of the environment in which people with disabilities live. It appears that services available are underused by disabled members of the community due to poor accessibility and financial barriers. The results yielded relatively enabling attitudes towards PWD. The responses suggest that this community may be ready to support increased participation by its members, possibly through a community based rehabilitation programme.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

How information is shared among CBR service providers in Uganda

COMMUNITY ACTION RESEARCH ON DISABILITY IN UGANDA
2008

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This study examines how information is shared among CBR programmes in Uganda and identifies challenges and strategies for improvement. Recommendations include the development of strategies for the oral means of information sharing; awareness raising of cost effective means of information sharing and using modes of communication that can reach people with special needs. This resource is useful for people interested in how information is shared among CBR programmes in Uganda

Community mental health policy

RADTKE, B
et al
2008

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This resource presents CBM’s community mental health (CMH) policy which "is human rights based, seeks to empower service users and facilitate their active participation in service provision, is culture, poverty and gender sensitive and based upon collaboration and networking with other organizations and the public sector." There are two main delivery models: integration of CMH into existing community-based rehabilitation (CBR) programmes, and implementation of CMH services into primary health care services provided by the government with sharing of resources or the implementation of stand-alone CMH services. This resource is useful for people interested in community mental health policy

WHO/ILEP technical guide on community-based rehabilitation and leprosy

WORLD HEALTH ORGANIZATION (WHO)
INTERANTIONAL FEDERATION OF ANTI-LEPROSY ASSOCIATIONS (ILEP)
2007

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This technical guide provides a reorientation and familiarisation tool for managers of leprosy projects and programmes. The analysis includes an outline of the broad objectives of CBR, the roles and tasks of programme managers, and the responsibilities of community workers. This resource would be useful for anyone with an interest in disability and development

Report on the 4th meeting of the development of CBR guidelines

WORLD HEALTH ORGANIZATION (WHO)
2007

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This report finalises each chapter of the first draft of the CBR Guidelines and decides on the layout, printing and production. Furthermore, the report addresses the dissemination strategy, fundraising strategy and the possibility to develop training packages for practitioners and design a future plan of action. This document is useful for people interested in CBR and the development of the CBR Guidelines

The origins of community-based rehabilitation

HELANDER, Einar
2007

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This article looks at the historical development of community-based rehabilitation (CBR). It is useful for people interested in the history of CBR Asia Pacific Disability Rehabilitation Journal, Vol 18, No 2

A review of community based rehabilitation evaluations : quality of life as an outcome measure for future evaluations

MANNAN, Hasheem
TURNBULL, Ann P
2007

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"This review examines key articles in evaluation of community-based rehabilitation carried out in developing countries and proposes family quality of life as an outcome measure of community-based rehabilitation. The concept of community-based rehabilitation is reviewed, quality of life and family quality of life measurement scale is presented. It presents a practical approach to future evaluations of community-based rehabilitation programmes. This review presents the features of community-based rehabilitation evaluation (i.e., service delivery system, technology transfer, community involvement, and organisation and management), methodology, and findings. Implications are defined for the enhancement of community based rehabilitation through practical suggestions for programme coordinators involved in community development for rehabilitation, equalisation of opportunities, and social inclusion of people with disabilities"

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Evaluation in community based rehabilitation programmes : a strengths, weaknesses, opportunities and threats analysis

SHARMA, Manoj
2007

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The purpose of this article was to qualitatively analyse the extent to which community based rehabilitation programmes have been evaluated over the past thirty years. A framework of strengths, weaknesses, opportunities and threats analysis was used in conducting this analysis. Using an extensive search of MEDLINE, 22 articles were located that described and evaluated one or more dimensions of CBR. Three studies each from Australia, India, Zimbabwe and two studies each from England, Philippines, Vietnam and one each from Finland, Guyana, Jamaica, Japan, Pakistan, Papua New Guinea, Thailand, and United States were included in the analysis. A variety of methods used, most evaluations conducted in community settings, focus on mobility related evaluations by most programmes, and development of new instruments were the strengths of CBR evaluations. Some of the weaknesses were lack of consistency in outcome measures, lack of cost benefit and cost effectiveness studies, small sample size of many studies, and lack of focus on other than mobility related disabilities by most projects. The opportunities for CBR evaluations pertain to training assessments, use of mixed models, using indicators from a standard taxonomy, and focusing on medical rehabilitation. The threats to CBR evaluations are a need to prioritise from multifarious activities and having limited resources for evaluation.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Beyond community based rehabilitation: consciousness and meaning

CHEAUSUWANTAVEE, Tavee
2007

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This article seeks to explore CBR through different perspectives. Based on existing literature and research on CBR, the paradoxes between CBR as ideal and CBR in usual practice, are identified. The dual meaning of 'disability' through 'stigma' and 'empowerment' perspectives is explored, along with the dual understanding of 'community consciousness' as 'individualism' and 'collectivism'. The two dimensions of 'disability' and 'consciousness' together are characterised into four distinct paradigms. Most past rehabilitation services are placed in a stigma-collective paradigm. It implies that philanthropy, inter-subjective value, morality and public awareness of society have usually constructed and supported any help and services for people with disabilities, including CBR. This paper looks at limitations of the past perspectives on CBR, and also points out the need for 'consciousness' studies on CBR. To understand the discrepancies of CBR, people need to look "beyond" CBR as it is commonly understood.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Twenty years of community-based rehabilitation in Guyana 1986-2006 : an impact assessment

DEEPAK, Sunil
2007

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"This impact assessment is based on a review of reports and studies from different sources related to Guyana CBR programme, and through a field visit." The report focuses upon achievements of the CBR programme over the past twenty years, with particular emphasis on the impact on the policies and practices of institutions in Guyana, the lives of children and adults with disabilities and the civil society & organisations in Guyana

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